1. ASEA 2006 Gluteal Fibrosis John Ekure Kumi Hospital Uganda

2. ASEA 2006 Introduction 28 cases of gluteal fibrosis From Aug 2004 to May 2005 All bilateral All were severe

3. ASEA 2006 Introduction 26/28 : cause = IM Quinine 2/28 : Cause = Streptomycin / Penicillin One case had paralytic drop foot Fibrous tissue was incised

4. ASEA 2006 Introduction Surgical complications: 1/28 : Temporary Sciatic nerve palsy 1/28 : Temporary Sciatic nerve palsy 2/28 : Deep sepsis 2/28 : Deep sepsis

5. 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

6. 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

7. ASEA 2006 Both buttocks had scars and were markedly wasted Difficulty in daily activities Surgical release improved quality of life

8. ASEA 2006

18. 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

19. 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

20. 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

21. ASEA 2006 Pathological findings During surgery : Very tense Fascia Lata Muscles replaced by fibrous tissue Histology : Intramuscular fibrosis without any signs of inflammation

22. 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.