Gluteal Fibrosis

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Gluteal Fibrosis

• John Ekure
• Kumi Hospital
• Uganda

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Introduction

• 28 cases of gluteal fibrosis
• From Aug 2004 to May 2005
• All bilateral
• All were severe

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Introduction

• 26/28 cause IM Quinine
• 2/28 Cause Streptomycin / Penicillin
• One case had paralytic drop foot
• Fibrous tissue was incised

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Introduction

• Surgical complications
• 1/28 Temporary Sciatic nerve palsy
• 2/28 Deep sepsis

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Description of the Cases

• O.k , an 8 yr old boy
• Difficulty in walking, squatting and sitting
  for 6yrs
• 2 to im quinine at the age of 2yrs
• Generally well except for buttocks

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• Hip flexion 30
• External rotation and abduction of 35 was
  necessary to obtain full flexion of the hips
• No adduction or internal rotation was possible
  with the hips fully flexed
• He could not sit on a mat with his knees extended
  and hips abducted

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• Both buttocks had scars and were markedly wasted
• Difficulty in daily activities
• Surgical release improved quality of life

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Pt. Profiles 28 Cases

• All lt 12 yrs
• Males 44.4
• im quinine commonest cause
• 2 Cases caused by Penicillin or streptomycin

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Analysis of the 28 Cases

• All children had small gluteal muscle masses
• Buttocks had injection scars
• Hip flexion in neutral only 30- 40
• When standing, the child kept an attitude of
  external rotation of both hips

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Analysis of the 28 Cases

• Running was impossible !!!!
• All bilateral
• Sitting impossible except on a high chair, with
  marked flexion of the lumbar spine
• Squatting was only possible in frog position

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Pathological findings

• During surgery Very tense Fascia Lata
• Muscles replaced by fibrous tissue
• Histology Intramuscular fibrosis without any
  signs of inflammation

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Discussion and Conclusions

• Gluteal fibrosis may be as a result of repeated
  im Quinine
• No cases were diagnosed at birth
• Surgical treatment is not without complications
• Gluteal fibrosis is preventable.