Bone and joint processes take second stage to life-threatening organ failure in the setting of critical illness. However, bone and joint disorders can cause significant impairment in survivors of critical illness. Return to pre-admission function is often limited by acquired complications such as joint contractures, heterotopic ossification, and altered bone metabolism. Critical care physicians should maintain a high index of suspicion for joint contractures, as they are often asymptomatic but the source of enduring disability once the critical illness had receded. Research is needed to document the effectiveness of alternate positioning, stretching, and bracing which are the current standard practice for prevention of contractures. Heterotopic ossification should be considered in the context of a swollen, warm, painful musculoskeletal site. Early detection with triple phase bone scan and, in some cases, prophylaxis with non-steroidal anti-inflammatory medication or radiation may be warranted. Bone hyperresorption in ICU patients can be caused by immobility, heightened inflammatory status, medication, hormonal changes, and vitamin D deficiency. Laboratory biomarkers can guide treatment, which is important to prevent long-term osteoporosis and stress fractures. Systematic physical examination and early patient mobilization may represent important steps to detect and prevent joint contractures and heterotopic ossification.
Development of Bilateral Heterotopic Ossification After Survival of Life Threatening Purpura Fulminans