ASEA 2006 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
ASEA 2006 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
ASEA 2006 Both buttocks had scars and were markedly wasted Difficulty in daily activities Surgical release improved quality of life
Pt. Profiles : 28 Cases All < 12 yrs Males = 44.4% im quinine = commonest cause im quinine = commonest cause 2 Cases caused by Penicillin or streptomycin
ASEA 2006 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
ASEA 2006 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
ASEA 2006 Pathological findings During surgery : Very tense Fascia Lata Muscles replaced by fibrous tissue Histology : Intramuscular fibrosis without any signs of inflammation
ASEA 2006 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.