Os aparelhos gessados são dispositivos rígidos de imobilização externa que envolvem uma região do corpo, de forma a mantê-la numa posição adequada. Estudo mecânico comparativo entre aparelhos gessados clássicos e de material sintético. JDMBA Rossi, FAS Caffali, TP Leivas, LA Menezes Filho, AA Quintela. Avaliação do aparelho gessado cruro-podálico articulado como complementação do tratamento cirúrgico do “genu valgum.” Front Cover. Hélio Lúcio de Souza.
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Heterotopic ossification can be defined as the formation of bone in tissues that have no ossification properties, such as in muscles and connective tissue of a periarticular region, without invasion of the joint capsule. This pathology usually has a benign course, but it can cause a reduction in the range of joint movement and hamper the rehabilitation process. Among its clinical manifestations, it may present pain and limitation of joint movement, heat, edema, and local flushing.
In some cases, it can present moderate fever, severe spasticity, and even ankylosis in more advanced stages of the disease. Treatment is based on resection of the ossification, with adjuvant measures such as non-steroidal anti-inflammatory drugs, bisphosphonate, radiotherapy, and physical therapy. None of these methods currently have a precise recommendation regarding dose, quantity, or well-established protocols.
Still, the best treatment is prevention. The objective of this report is to describe a case of heterotopic ossification in the hip after traumatic brain injury, presenting the clinical manifestations and discussing the treatment instituted with a long leg plaster aparelhhos. Heterotopic ossification HO is a process of abnormal osteogenesis in non-skeletal geessados, due to an initial metaplastic and inflammatory apraelhos, through bone neoformation in soft tissues; it is not considered a neoplasia.
It usually occurs in the large joints. It may involve one or more joints in the same patient; in this case, the involvement is usually bilateral. The etiology of HO is still uncertain. The initial clinical manifestations of HO include pain and limitation of joint movement, heat, edema, local flushing, and, in some cases, moderate fever and severe spasticity.
HO presents with elevated serum alkaline phosphatase AP levels, and a transient decrease in serum calcium levels preceding the first event. Increased AP is also observed in the presence of fractures and liver diseases. The diagnosis is made through conventional radiography. Computed tomography CT can also be used.
The treatment of HO is often conservative and prevention is the most appropriate conduct; however, surgical intervention may be necessary. A year-old male patient was treated in at the orthopedic outpatient clinic of a public university gezsados, complaining of pain and progressive limitation of movement in geesados hips, as well as loss of right lower limb RLL muscle strength after suffering physical aggression approximately 8 months earlier.
After the aggression, he evolved with TBI and was bedridden due to a bilateral hip contracture Fig. On physical examination, he was in good general condition and was afebrile.
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The right and left hips presented, respectively, flexion: An anteroposterior view radiograph of the hip showed areas of periarticular hip ossification, bilaterally, and the diagnosis of HO was made Fig.
Due to the high rates of recurrence with resection surgery, the authors chose to manipulate the right hip joint under anesthesia, placing a full leg plaster cast on the right lower limb on July 10,without any complications.
Immediately after the manipulation, in the operation room, the right hip’s range of motion ROM was measured: A wedge was made in the alarelhos 5 days later, and the patient was discharged on July 17, After 2 weeks, the patient returned to the outpatient clinic to zparelhos the cast; and had no complaints. The cast was used for 9 months. Shortly after its removal, the patient began walking with crutches for short distances and later, after several physical therapy sessions, apwrelhos crutches.
Two gedsados after the manipulation, the following right hip Aparehos values were registered: Hip ROM improvement was observed in general and mainly in flexion, abduction, and internal rotation movements Aparelhis.
The clinical picture of the patient enhanced, as the functional aspect of the hip improved; despite the limitations, a previously bedridden patient was able to walk again Fig. It is important to note that HO treatment is often conservative, provided that differential diagnoses have been definitively ruled out deep vein thrombosis, osteosarcoma, and septic arthritis, among others.
Exercises are recommended to maintain joint mobility. Surgical resection often gesados to increased aggression and, consequently, to new areas of tissue ossification.
It should only be performed in cases with hip movement restrictions, in order to release the ankylosed joints and entrapped nerves. Furthermore, resection can cause excessive bleeding particularly in the femurand lead to increased morbidity and mortality, and if it is performed before bone maturity, there are high chances of relapse.
Bisphosphonates can be used prophylactically to prevent recurrence of surgically excised heterotopic bones. It is believed that recurrence is associated with the presence of osteoblastic activity at the HO site at the time of resection.
That is, remaining osteoblastic gezsados would be responsible for recurrence, similarly to what is observed in cases of incomplete neoplasia resection. Thus, surgery should be performed months after the end of the active stage of the injury. In patients with spinal cord injury, early HO diagnosis is of utmost importance so that adequate treatment can be initiated and the chance of progression to ankylosis of the joint reduced.
TEC.APARELHO GESSADO E VENDEDOR AUTONOMO DE LATICINIOS.
However, surgical HO resection is usually not indicated for patients classified as Brooker grade I and II, and sometimes as grade III lesions, because of the low functional impact since gessdaos do not present active movement of the lower limbs, with risk of complications and relapses. Thus, surgical excision must be carefully and individually considered and reserved for fully matured HO cases in patients with severe functional joint impairment.
Rehabilitation medicine plays an important role in approaching these patients by addressing the symptoms and improving the function of the affected body areas, allowing family, social, and occupational reintegration of these patients. Any treatment option that improves the quality of life of the patient mitigates the negative impact of this disease.
In this case, the full leg plaster cast allowed the patient to walk, despite the ROM limitation. Treatment through hip manipulation associated with a plaster cast showed excellent results. The patient was able to improve the movements of extension, abduction, and adduction of the right hip, which allowed gait without the risks of resection surgery.
Treatment of heterotopic ossification of the hip with use of a plaster cast: Hip contracture before treatment, more significant on the right; the hip is in flexion, abduction, and external rotation. Appearance 2 years after treatment.
Improvement of extension, abduction, and adduction of the right hip. Patient 2 years after treatment, now able to walk. Rev Col Bras Gessadks. The role of radiotherapy for prevention of heterotopic ossification gessqdos major hip surgery. A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res. Risk factors of heterotopic ossification in traumatic spinal cord injury.
Leite NM, Faloppa F. Naproxen in prevention of heterotopic ossification after total hip replacement.