asea 2006 gluteal fibrosis john ekure kumi hospital uganda

ASEA 2006ASEA 2006

Gluteal FibrosisGluteal Fibrosis

John EkureJohn Ekure

Kumi HospitalKumi Hospital

UgandaUganda

ASEA 2006ASEA 2006

IntroductionIntroduction

28 cases of gluteal fibrosis 28 cases of gluteal fibrosis

From Aug 2004 to May 2005 From Aug 2004 to May 2005

All bilateralAll bilateral

All were severe All were severe

ASEA 2006ASEA 2006


26/28 : cause = IM Quinine26/28 : cause = IM Quinine

2/28 : Cause = Streptomycin / Penicillin2/28 : Cause = Streptomycin / Penicillin

One case had paralytic drop foot One case had paralytic drop foot

Fibrous tissue was incised Fibrous tissue was incised

ASEA 2006ASEA 2006


Surgical complications:Surgical complications:

1/28 : Temporary Sciatic nerve palsy1/28 : Temporary Sciatic nerve palsy

2/28 : Deep sepsis2/28 : Deep sepsis

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Description of the CasesDescription of the Cases

O.k , an 8 yr old boyO.k , an 8 yr old boy

Difficulty in walking, squatting and sitting Difficulty in walking, squatting and sitting for 6yrsfor 6yrs

22° to° to im quinine at the age of 2yrs im quinine at the age of 2yrs

Generally well except for buttocksGenerally well except for buttocks

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Hip flexion 30 °Hip flexion 30 °

External rotation and abduction of 35° was necessary External rotation and abduction of 35° was necessary to obtain full flexion of the hips to obtain full flexion of the hips

No adduction or internal rotation was possible with the No adduction or internal rotation was possible with the hips fully flexedhips fully flexed

He could not sit on a mat with his knees extended He could not sit on a mat with his knees extended and hips abducted and hips abducted

ASEA 2006ASEA 2006

Both buttocks had scars and were Both buttocks had scars and were markedly wastedmarkedly wasted

Difficulty in daily activitiesDifficulty in daily activities

Surgical release improved quality of lifeSurgical release improved quality of life

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ASEA 2006ASEA 2006

Pt. Profiles : 28 CasesPt. Profiles : 28 Cases

All < 12 yrsAll < 12 yrs

Males = 44.4%Males = 44.4%

im quinine = commonest causeim quinine = commonest cause

2 Cases caused by Penicillin or streptomycin2 Cases caused by Penicillin or streptomycin

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Analysis of the 28 CasesAnalysis of the 28 Cases

All children had small gluteal muscle massesAll children had small gluteal muscle masses

Buttocks had injection scarsButtocks had injection scars

Hip flexion in neutral only 30°- 40°Hip flexion in neutral only 30°- 40°

When standing, the child kept an attitude of When standing, the child kept an attitude of external rotation of both hipsexternal rotation of both hips

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Analysis of the 28 CasesAnalysis of the 28 Cases

Running was impossible !!!!Running was impossible !!!!

All bilateralAll bilateral

Sitting impossible except on a high chair, with Sitting impossible except on a high chair, with marked flexion of the lumbar spinemarked flexion of the lumbar spine

Squatting was only possible in frog positionSquatting was only possible in frog position

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Pathological findingsPathological findings

During surgery : Very tense Fascia LataDuring surgery : Very tense Fascia Lata

Muscles replaced by fibrous tissueMuscles replaced by fibrous tissue

Histology : Intramuscular fibrosis without any Histology : Intramuscular fibrosis without any signs of inflammation signs of inflammation

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Discussion and ConclusionsDiscussion and Conclusions

Gluteal fibrosis may be as a result of repeated Gluteal fibrosis may be as a result of repeated im Quinine im Quinine

No cases were diagnosed at birthNo cases were diagnosed at birth

Surgical treatment is not without complicationsSurgical treatment is not without complications

Gluteal fibrosis is preventable.Gluteal fibrosis is preventable.

asea 2006 gluteal fibrosis john ekure kumi hospital uganda

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