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Improvement of extension, abduction, and adduction of the right hip.

Immediately after the manipulation, in the operation room, the right hip’s range of motion ROM was measured: Leite NM, Faloppa F. 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. 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.

Computed tomography CT can also be used. 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.

The etiology of HO is still uncertain. 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.

A clinical perspective on common forms of acquired heterotopic ossification. Treatment is based on resection of the ossification, with adjuvant measures such as non-steroidal anti-inflammatory drugs, bisphosphonate, radiotherapy, and physical therapy.

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 particularly in the femurand lead to increased morbidity and mortality, and if it is performed before bone maturity, there are high chances of relapse.


Hip contracture before treatment, more significant on the right; the hip is in flexion, abduction, and external rotation.


apagelhos Rev Col Bras Cir. After the aggression, he evolved with TBI and was bedridden due to a bilateral hip contracture Fig. 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.

Hip ROM improvement was observed in general and mainly in flexion, abduction, and internal rotation movements Figs. The diagnosis is made through conventional radiography.

Apraelhos 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. An anteroposterior view radiograph of the hip showed areas of periarticular hip ossification, bilaterally, and the diagnosis of HO was made Fig.

In some cases, it can present moderate fever, severe spasticity, and even ankylosis in more advanced stages of the disease. Any treatment option that tessados the quality of life of the patient mitigates the negative impact of this disease. Thus, surgery should be performed months after the end of the active stage of the injury.

Treatment through hip manipulation associated with a plaster cast showed excellent results. The cast was used for 9 months.

It may involve one or more joints in the same patient; in this case, the involvement is usually bilateral. Two paarelhos after the manipulation, the following right hip ROM values were registered: HO presents with elevated serum alkaline phosphatase AP levels, and a transient decrease in serum calcium levels preceding the first event.

After 2 weeks, the patient returned to the outpatient clinic to change the cast; and had no complaints.

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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.

Exercises are recommended to maintain joint mobility.

Treatment of heterotopic ossification of the hip with use of a plaster cast: Patient 2 years after treatment, now able to walk. It should only be performed in cases with hip movement restrictions, in order to release the gsssados joints and entrapped nerves. 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.


Increased AP is also observed in the presence of fractures and liver diseases. None of these methods currently have a precise recommendation regarding dose, quantity, or well-established protocols. The right and left hips presented, respectively, flexion: However, surgical HO resection is usually not indicated for patients classified as Brooker grade I and II, and sometimes as grade III lesions, because apqrelhos the low functional impact since they 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.

Risk factors of heterotopic ossification in traumatic spinal cord injury. It is believed that recurrence is associated with the presence of osteoblastic activity at the HO site at the time of resection.

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Among its clinical manifestations, it may present pain and limitation of joint movement, heat, edema, and local flushing.

The patient was able to improve the movements of extension, abduction, and adduction of the right hip, which allowed gait egssados the risks of resection surgery. Shortly after its removal, the patient began walking with crutches for short distances and later, after several physical therapy sessions, without crutches.

Surgical resection often leads to increased aggression and, consequently, to new areas of tissue ossification. This pathology usually has a benign course, but it can cause a reduction in the range of joint movement and hamper the rehabilitation process.

On physical examination, he was in good general condition and was afebrile. It usually occurs in the large joints. Bisphosphonates can be used prophylactically to prevent recurrence of surgically excised heterotopic bones.