Primum non nocere: a case of a humeral fracture in a patient with fibrodysplasia progressiva ossificans.

Abstract

Fibrodysplasia progressiva ossificans (FPO) is an extremely rare condition characterized by abnormal heterotopic bone formation. The condition is eponymously known as 'stoneman' disease because patients can become effectively entombed within abnormal heterotopic bone. We present the first known case of a diaphyseal humeral fracture managed conservatively in an adult patient with this condition. This patient already had a pre-existing bony bar from a fusion mass involving the thoracic spine, scapula and ribs to her proximal humerus splinting the arm in a position of adduction with the palm of her hand facing towards her groin. This patient also suffered a concomitant unstable cervical spinal fracture for which full spinal precautions were needed. As a result of the rapid bone forming nature of her condition, the humeral fracture was placed in a position where the hand would face outwards to make perineal care and personal hygiene easier in that the fracture was expected to unite in this new position as a result of her FPO.