A Nordqvist

Andrew Richards

CD Huss

Gil T Railton

HA Fairbank

JB Ryan

JM Beiner

LV Ackerman

Ravi Trehan

Shelain Patel

TP Noble

English

PubMed

Springer - Publisher Connector

BioMed CentralCases Journal
ssOpen AcceCase Report
Post-traumatic myositis ossificans of the sternocleidomastoid 
following fracture of the clavicle: a case report
Shelain Patel*, Andrew Richards, Ravi Trehan and Gil T Railton
Address: Department of Trauma & Orthopaedics, Kingston Hospital, Kingston-upon-Thames, Surrey, UK
Email: Shelain Patel* - shelain.patel@doctors.org.uk; Andrew Richards - andrew.richards@kinsgtonhospital.nhs.uk; 
Ravi Trehan - trehanravi@hotmail.com; Gil T Railton - gil.railton@kingstonhospital.nhs.uk
* Corresponding author    
Abstract
Background: Fractures of the clavicle are common injuries. The complications have been well
documented in the literature.
Case presentation: Despite it close proximity to the sternocleidomastoid muscle and myositis
ossificans recognised as a known complication of any fracture, the two have never previously been
described in association secondary to a fracture of the clavicle. We present a case where myositis
ossificans affecting the sternocleiodomastoid was detected in the post-injury phase of a clavicle
fracture.
Conclusion: This case highlights that traumatic myositis ossificans circumscipta can arise in the
sternocleidomastoid muscle following a fracture of the medial third of the clavicle.
Background
Fractures of the clavicle are common, accounting for 7%
of all fractures [1]. The complications of this fracture are
well documented, but traumatic myositis ossificans cir-
cumscipta as a complication has not been previously
described. We present a case of a 46 year old male whose
clavicle fracture was complicated by traumatic myositis
ossificans of the sternocleidomastoid muscle. Both frac-
ture and complication were managed non-operatively.
Case report
A 46 year old gentleman presented to the emergency
department following a fall onto his left side whilst intox-
icated with alcohol. His past medical history included
alcohol dependency and peptic ulcer disease. He com-
plained of pain over the medial half of the left clavicle.
Examination revealed swelling and bony tenderness over
the clavicle 3 cm distal to the left sternoclavicular joint.
There were no documentation of masses in his neck and
movement in his neck was unchanged from normal. Radi-
ographs showed a displaced fracture of the proximal 1/3
of the left clavicle (Figure 1). He was given a broad arm
sling by the emergency department and was referred to the
out-patient fracture clinic for follow up.
He was seen 8 days later in the out-patient fracture clinic.
Examination revealed marked bruising over the fracture
site. Furthermore, a hard, well-circumscribed mass arising
from the left clavicle and extending into the sternocleido-
mastoid muscle was identified. Follow up radiographs
were taken (figure 2). Based on the radiographic findings
of extra-osseous calcification, a CT scan was performed
(figures 3, 4 &5). This demonstrated an extra-osseous cal-
cification within the sternocleidomastoid muscle.
Published: 22 December 2008
Cases Journal 2008, 1:413 doi:10.1186/1757-1626-1-413
Received: 9 December 2008
Accepted: 22 December 2008
This article is available from: http://www.casesjournal.com/content/1/1/413
© 2008 Patel et al; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 3
(page number not for citation purposes)
Cases Journal 2008, 1:413 http://www.casesjournal.com/content/1/1/413Traumatic myositis ossificans circumscripta was diag-
nosed. The patient was informed that his condition would
be managed non-operatively. Non-steroidal anti-inflam-
matory medications were not prescribed due to his past
history of peptic ulcer disease and current excessive alco-
hol usage. Plans were made for him to be followed up in
the out-patient clinic to monitor his condition, but he
failed to attend any further follow-up appointments.
Oblique radiograph of the left clavicle demonstrating a frac-ture of the medial third (day 0)Figure 1
Oblique radiograph of the left clavicle demonstrating 
a fracture of the medial third (day 0).
AP radiograph of the left clavicle demonstrating a fracture of the medial third with an op city extending from the fracturesit  in the soft tissu s of the neck (day 8)Figur  2
AP radiograph of the left clavicle demonstrating a 
fracture of the medial third with an opacity extend-
ing from the fracture site in the soft tissues of the 
neck (day 8).
Axial CT image showing a displaced fracture of the left clavi-cle (day 8)Figure 3
Axial CT image showing a displaced fracture of the 
left clavicle (day 8).
Axial CT image showing a well circumscribed osseous lesion within the sternocleidom stoid muscle above the site of the fracture (day 8)Figure 4
Axial CT image showing a well circumscribed 
osseous lesion within the sternocleidomastoid mus-
cle above the site of the fracture (day 8).Page 2 of 3
(page number not for citation purposes)
Cases Journal 2008, 1:413 http://www.casesjournal.com/content/1/1/413Conclusion
Myositis ossificans is described as extra-osseous, localised,
non-neoplastic formation of bone and cartilage [2]. It can
be classified in to three types [3]:
(1) Myositis ossýficans progressiva which is a metabolic dis-
order occurring in children with widespread metamor-
phosis of muscle into bone, all of the skeletal muscles
becoming involved progressively.
(2) Traumatic myositis ossificans circumscripta which follows
local trauma which may be either acute or chronic
repeated injuries.
(3) Myositis ossýficans circumscripta without history of
trauma. This is usually found in paraplegia, chronic infec-
tions, burns and poliomyelitis, but may occur independ-
ently of these conditions.
The aetiology of traumatic myositis ossificans is
unknown. The most common sites to be affected are the
hip, anterior thigh (quadriceps), and anterior arm (bra-
chialis) [4,5]. It appears to be a self limiting disease with
spontaneous resolution after maturation in most cases,
though some can take years to resolve [6].
Histologically, the "zone phenomena" has been described
by Ackerman [2] where the lesion is separated in to inner,
middle and outer zones.
• Central zone: extreme variation of cells and atypical
mitotic figures
• Middle zone: orientated osteoid
• Outer zone: well formed bone
Myositis ossificans of the sternocleidomastoid muscle was
first described in 1950 [7] though this was due to myositis
ossificans progressiva, rather than following trauma. Post-
traumatic cases of myositis ossificans of the sternocleido-
mastoid have been described, but no case has previously
been reported as a consequence of a fracture of the clavi-
cle.
This case highlights that traumatic myositis ossificans cir-
cumscipta can arise in the sternocleidomastoid muscle
following a fracture of the medial third of the clavicle.
Consent
Written informed consent was obtained from the patient
for publication of this case report and any accompanying
images. A copy of the written consent is available for
review by the Editor-in-Chief of this journal.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
SP, AMR, RT and GTR were involved in the clinical care of
the patient and drafting of the manuscript. All authors
have read and approved the final manuscript.
References
1. Nordqvist A, Petersson C: The incidence of fractures of the
clavicle.  Clin Orthop Relat Res 1994, 300:127-32.
2. Ackerman LV: Extra-osseous Localized Non-neoplastic Bone
and Cartilage Formation (So-called Myositis Ossificans):
clinical and pathological confusion with malignant neo-
plasms.  J Bone Joint Surg Am 1958, 40-A(2):279-98.
3. Noble TP: Myositis Ossificans, a Clinical and Radiological
Study.  Surgery, Gynecology and Obstetrics 1924, 39:795.
4. Huss CD: Myositis ossificans of the upper arm.  Am J Sports Med
1980, 8(6):419-424.
5. Ryan JB, Wheeler JH, Hopkinson WJ, Arciero RA, Kolakowski KR:
Quadriceps contusions: West Point update.  Am J Sports Med
1991, 19:299-304.
6. Beiner JM, Jokl P: Muscle contusion injury and myositis ossifi-
cans traumatica.  Clin Orthop Relat Res 2002, 403:S110-9.
7. Fairbank HA: Myositis Ossificans Progressiva.  J Bone Joint Surg Br
1950, 32-B(1):108-16.
Reformatted coronal CT image showing a fracture of the clavicle with an osseous lesion within the sternocleidomas-toid muscl  (day 8)Figu  5
Reformatted coronal CT image showing a fracture of 
the clavicle with an osseous lesion within the sterno-
cleidomastoid muscle (day 8).Page 3 of 3
(page number not for citation purposes)


Post-traumatic myositis ossificans of the sternocleidomastoid following fracture of the clavicle: a case report

Crossref

Extra-osseous Localized Non-neoplastic Bone and Cartilage Formation (So-called Myositis Ossificans): clinical and pathological confusion with malignant neoplasms.

KR: Quadriceps contusions: West Point update.

Muscle contusion injury and myositis ossificans traumatica. Clin Orthop Relat Res

Myositis ossificans of the upper arm.

Myositis Ossificans, a Clinical and Radiological Study. Surgery, Gynecology and Obstetrics

Petersson C: The incidence of fractures of the clavicle. Clin Orthop Relat Res

file:///data/core-remote/dit/data/Springer-OA/pdf/15c/aHR0cDovL2xpbmsuc3ByaW5nZXIuY29tLzEwLjExODYvMTc1Ny0xNjI2LTEtNDEzLnBkZg==.pdf

Post-traumatic myositis ossificans of the sternocleidomastoid following fracture of the clavicle: a case report

Abstract

Similar works

Full text

Available Versions

Springer - Publisher Connector

Springer - Publisher Connector

Crossref