The incidence of heterotopic ossification (HO) in adult patients with spinal cord injuries is roughly 20%. HO usually has a benign development, but can reduce the range of joint motion and hinder the rehabilitation process. Few studies have shown the use of radiotherapy in the treatment of HO in patients with spinal cord injuries. The objective of this study is to assess whether immature heterotopic ossification progresses in patients with spinal cord injuries submitted to radiotherapy as the primary treatment. The medical records of patients attending the spinal cord injury clinic of AACD (Associação de Assistência à Criança Deficiente) with immature HO and who were treated exclusively with radiotherapy were selected. This is a historical cohort-type study. Ossification progress was determined by analysis of the range of motion of the affected joint, measurements with a goniometer and radiographic image. Ossification was classified according to the classification proposed by Brooker et al. The study follow-up period was 23.3 months. Fourteen of the 15 studied joints did not worsen clinically, nor did the HO progress. None of the patients had side effects from radiotherapy. We conclude that patients treated early with radiotherapy do not present significant HO development and that radiotherapy is a safe and easy-to-use method.

No abstract

Orthopedic surgery is often used to improve the gait of ambulatory patients with cerebral palsy. The objectives may change, given the motor severity, however, an improve in the patient’s mobility can be achieved through surgical procedures of the lower extremity. The Gross Motor Function Measure (GMFM) is a measure of gross motor function, used to evaluate therapeutic choices, rehabilitation progress and in our institution, to evaluate, orthopedic surgeries. Objective: The main goal of this study was to evaluate orthopedic surgeries performed in children with cerebral palsy, through comparison of the GMFM’s score pre and post procedure. Method: We included in this study, patients with great limitation in mobility function but potential to improve (Levels III and IV of the Gross Motor Function Classification System), that underwent surgical procedures between January 2010 and December 2012, achieving a total of 36 subjects. Results: There was no statistically significant change between the measures, except for the C domain (crawling and kneeling), that presented a lower post-surgical procedure score. Age, time of follow up, the surgery’s characteristic, and, most of all, the instrument used, which in our case was the GMFM, were pointed as possible difficulties in measuring objectively the results of lower extremity surgery in children with cerebral palsy. Conclusion: A larger sample of subjects evaluated through a more appropriate instrument is still necessary to acknowledge the real effects of orthopedic surgery of lower extremity in patients with cerebral palsy.

Em pacientes com paralisia cerebral (PC) deambuladores, a cirurgia ortopédica é bastante utilizada para melhora do padrão de marcha. Conforme aumenta o acometimento motor, os objetivos podem mudar, contudo, uma melhora na mobilidade é importante e pode ser conseguida através de procedimentos cirúrgicos. A Gross Motor Function Measure (GMFM) é uma escala quantitativa da função motora grossa, utilizada para diversos fins, como controle da evolução terapêutica, progressos na reabilitação e, em nosso serviço, avaliação de cirurgias ortopédicas. Objetivo: A avaliação padronizada e sistematizada dessas cirurgias, comparando a GMFM pré e pós procedimento. Método: Incluímos no estudo aqueles pacientes que apresentam uma maior limitação da mobilidade e com potencial para melhorar sua movimentação (níveis III e IV da Gross Motor Function Classification System), operados entre janeiro de 2010 e dezembro de 2012 obtendo 36 pacientes. Resultados: Notamos que não houve diferença estatisticamente significante entre os momentos da GMFM, a não ser, no domínio C (engatinhar e ajoelhar), no qual notamos uma queda da pontuação. A idade dos pacientes, o tempo de aferição entre as medidas, a natureza da cirurgia e, principalmente, o método de avaliação, que em nosso caso, foi a GMFM, foram citados na literatura como dificuldades em se quantificar objetivamente o resultado obtido pelas cirurgias ortopédicas de membros inferiores em pacientes com PC. Conclusão: Uma avaliação de um número maior de pacientes, talvez com um instrumento diferente do utilizado em nosso trabalho, se faz necessária para uma melhor percepção do real efeito da cirurgia ortopédica de membros inferiores em pacientes com PC.