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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The objective of this report is to describe a case of heterotopic ossification in the hip after traumatic brain injury, presenting the clinical manifestations gessadoos discussing the treatment instituted with a long leg plaster cast. Risk factors of heterotopic ossification in traumatic spinal cord injury. Leite NM, Faloppa F. Patient 2 years after treatment, now able to walk.
HO presents with elevated serum alkaline phosphatase AP levels, and a gedsados decrease in serum calcium levels preceding the first event. Clin Orthop Relat Res. It is important to note that HO treatment is often conservative, provided that differential diagnoses have been definitively ruled out deep vein aparelyos, osteosarcoma, and septic arthritis, among others. 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.
Gessqdos resection often leads to increased aggression and, consequently, to new areas of tissue ossification. Any treatment option that improves the quality of life of the patient mitigates the negative impact of this disease. 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.
Furthermore, resection can cause excessive bleeding apaeelhos in the femurand lead to increased morbidity and mortality, and if it is performed before bone maturity, there are high chances of relapse.
Gezsados 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. 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. Rev Col Bras Cir. A wedge was made in the cast 5 days later, and the patient was discharged on July 17, The role of radiotherapy for prevention of gesssados ossification after major hip surgery. The diagnosis is made through conventional radiography. A clinical perspective on common forms of acquired heterotopic ossification.
Apareelhos the aggression, he evolved with TBI and was bedridden due to a bilateral hip contracture Fig.
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It should only be performed in cases with hip movement restrictions, in order to release the ankylosed joints and entrapped nerves. It is believed that recurrence is associated with the presence of osteoblastic activity at the HO site at the time of resection.
Hip contracture before treatment, more significant on the right; the hip is in flexion, abduction, and external rotation. 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.
It usually occurs in the large joints. Shortly after its removal, the patient began walking with crutches for short distances and later, after several physical therapy sessions, without crutches.
After 2 weeks, the patient returned to the outpatient clinic to change the cast; and had no complaints. It may involve one or more joints in the same patient; in this case, the involvement is usually bilateral. Heterotopic ossification HO is a process of abnormal osteogenesis in non-skeletal tissues, due to an initial metaplastic and inflammatory process, through bone neoformation in soft tissues; it is not considered a neoplasia.
Bisphosphonates can be used prophylactically to prevent recurrence of surgically excised heterotopic bones. A year-old male patient was treated in at the orthopedic outpatient clinic of a public university hospital, complaining of pain and progressive limitation of movement in the hips, as well as loss of right lower limb RLL muscle strength after suffering physical aggression approximately 8 months earlier. 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. Still, the best treatment is prevention. 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.
The right and left hips presented, respectively, flexion: 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. That is, remaining osteoblastic cells would be responsible for recurrence, similarly to what is observed in cases of incomplete neoplasia resection. In this case, the full leg plaster cast allowed the patient to walk, despite the ROM limitation.
Appearance 2 years after treatment. Improvement of extension, abduction, and adduction of the right hip. Hip ROM improvement was observed in general and mainly in flexion, abduction, and internal rotation movements Figs.
The cast was used for 9 months. Treatment of heterotopic ossification of the hip with use of a plaster cast: The etiology of HO is still uncertain. The treatment of HO is often conservative and prevention is the most appropriate zparelhos however, surgical intervention may be necessary.
On physical examination, he was in good general condition and was afebrile.
An anteroposterior view radiograph of the hip showed areas of periarticular hip ossification, bilaterally, and the diagnosis of HO was made Fig. 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 paarelhos functional impact since they do not present active movement of the lower limbs, with risk of complications and relapses.