A case report: New technique of proximal lengthening for treatment of injection induced rectus femoris muscle contracture.

UNLABELLED: Contracture of quadriceps femoris muscle is an uncommon condition in clinical practice. It was suggested that intramuscular injections into the thigh for children are sometimes the cause of this condition.

CASE REPORT: The case presents a new surgical technique for the treatment of isolated rectus femoris muscle contracture. The patient is a 6- year-old boy complaining of external rotation of the left leg when he walks and inability to squat. Clinical examination showed positive Ely's test which indicated isolated rectus femoris muscle contracture. The patient underwent proximal lengthening of rectus femoris muscle.

DISCUSSION: Quadriceps femoris muscle contracture in children can be congenital or acquired. The identified causes of this case are multiple intramuscular injections, trauma or ischemia. The recommended treatment is proximal release in the early stage if contracture is diagnosed and distal lengthening of quadriceps tendon in the late stage. Surgical techniques that preserve continuity of the rectus femoris muscle have better outcomes, and give opportunity for second lengthening surgery if needed. This article presents a surgical technique of proximal rectus femoris muscle release that depends on using the length of the indirect head by transferring its attachment to the distal end of the direct head.

CONCLUSION: Quadriceps femoris contracture in children leads to limited knee flexion. Proximal release in the early stage gives excellent result. The technique used in this research gives an opportunity to restore knee flexion and a chance for second release if needed.