Transcript Gluteal Fibrosis: - Kumi Hospital Uganda

Gluteal Fibrosis
John Ekure
Kumi Hospital
Uganda
ASEA 2006
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 < 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.
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