Pathological bone regeneration in soft tissues: a narrative review of traumatic heterotopic ossification

Wang, Zheng1,2,#; Zhang, Dong1,2,#; Jian, Chao1,2; Qi, Baiwen1,2; Li, Zonghuan1,2,*; Yu, Aixi1,2,*

1Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China

2Hubei Clinical Medical Research Center of Orthopedic Trauma and Microsurgery, Wuhan, Hubei Province, China

*Correspondence to: Zonghuan Li, MD, lizonghuan@whu.edu.cn; Aixi Yu, MD. yuaixi@whu.edu.cn.

#Both authors contributed equally to this work and share first authorship.

Abstract

Traumatic heterotopic ossification is a pathological condition characterized by the abnormal formation of mature bone in soft tissues following trauma, burns, or surgical interventions. This condition can lead to functional impairment, pain, and a decreased quality of life for patients. Heterotopic ossification is a form of pathological bone regeneration, and its treatment primarily focuses on inhibiting pathological bone formation. This review synthesizes the latest insights into the pathogenesis, risk factors, and clinical management of traumatic heterotopic ossification, highlighting current gaps in knowledge and proposing directions for future research. Although there has been significant progress in understanding of the pathophysiology of traumatic heterotopic ossification, its underlying mechanisms remain not fully elucidated. These mechanisms involve complex interactions among inflammation, mesenchymal stem cell differentiation, genetic susceptibility, and various signaling pathways. Current treatment strategies primarily emphasize prevention through pharmacological interventions, such as non-steroidal anti-inflammatory drugs and bisphosphonates, while surgical resection is considered for severe cases. Emerging approaches, including targeted molecular therapies, hold promise for more effective and personalized treatment.

软组织中的病理性骨再生：一项创伤性异位骨化的叙述性综述

摘要

创伤性异位骨化是一种骨组织的病理状态，其特点是创伤、烧伤或手术干预后软组织中成熟骨的异常形成，这种情况会导致患者功能受损、疼痛和生活质量下降。异位骨化实质上是一种病理性骨再生，其治疗方法主要是抑制病理性骨再生。此综述综合了对创伤性异位骨化发病机制、风险因素和临床治疗的最新见解，强调了目前的知识空白，并提出了未来的研究方向。目前尽管研究者们对创伤性异位骨化的病理生理学有了进一步的了解，但其潜在机制仍未完全阐明，其中涉及炎症、间充质干细胞分化、遗传易感性和信号通路之间复杂的相互作用。目前的创伤性异位骨化治疗策略主要侧重于通过药物干预（如非甾体抗炎药和双膦酸盐）预防骨组织的病理性再生，并对严重病例进行手术切除，此外还包括靶向分子疗法在内的新兴方法有望实现更有效的个性化治疗。