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Case Reports
. 2024 Jul:120:109835.
doi: 10.1016/j.ijscr.2024.109835. Epub 2024 May 31.

Surgical treatment of injection-induced rectus femoris muscle contracture in a child: A case report

Qusai Razzouk  1 , Mohammed Al-Mahdi Al-Kurdi  2 , Mohammed Diab  2 , Mohamed Khair Kajjan  2 , Hani Alloush  3
Affiliations
Case Reports

Surgical treatment of injection-induced rectus femoris muscle contracture in a child: A case report

Qusai Razzouk et al. Int J Surg Case Rep. 2024 Jul.

Abstract

Introduction and importance: Quadriceps contracture, characterized by the shortening of the quadriceps muscle and reduced knee flexion, poses challenges in daily activities. The etiology of this condition includes congenital, traumatic, infective, or iatrogenic factors.Treatment typically involves surgical intervention, with various techniques described in the literature. Differentiating between isolated rectus femoris contracture and combined rectus and quadriceps contractures is crucial for appropriate management.

Case presentation: A 14-year-old female presented with gait disturbance and limitations in sitting and squatting due to rectus femoris contracture secondary to repetitive intramuscular injections. Physical examination revealed restricted knee flexion and positive Ely's test. The patient underwent rectus femoris lengthening (RFL) surgery, resulting in improved knee flexion and hip extension. Postoperatively, early mobilization and physiotherapy were initiated, leading to complete recovery with no complications during a three-year follow-up.

Clinical discussion: Quadriceps femoris muscle contracture in childhood can result from congenital factors or acquired causes such as injections, trauma, infections, or ischemia. In Syria, injection-induced contractures are prevalent due to widespread intramuscular drug administration. Differentiating between isolated rectus femoris contracture and combined quadriceps contracture is crucial for treatment selection. Surgical intervention, such as rectus femoris lengthening using the Z-plasty procedure, yields favorable outcomes. Postoperative physiotherapy is essential. Incision necrosis is a common complication, mitigated by careful incision placement.

Conclusion: Injection-induced rectus femoris contracture is common in children due to repeated thigh injections. Healthcare providers should consider alternative administration sites and routes to prevent contractures.

Keywords: Case report; Injection-induced; Orthopedic surgery; Quadriceps Plasty; Quadriceps contracture; Rectus femoris.

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Conflict of interest statement

Conflict of interest statement No conflicts of interest.

Figures

Fig. 1
Fig. 1
Ely's test.
Fig. 2
Fig. 2
Test which the Patient seated, partially lowered affected limb.
Fig. 3
Fig. 3
The rectus femoris muscle of the quadriceps femoris muscle before lengthening.
Fig. 4
Fig. 4
The rectus femoris muscle of the quadriceps femoris muscle after lengthening.
Fig. 5
Fig. 5
Clinical examination of the patient after follow-up.
See this image and copyright information in PMC

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