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Case report

A multidisciplinary approach to optimizing long-term functional prognosis of a girl with quadriceps fibrosis

Jessica Luthringer, Marc Garetier, Mathieu Lempereur, Laetitia Houx, Valérie Burdin, Juliette Ropars, Douraied Ben Salem, Camille Printemps, Sylvain Brochard, Christelle Pons
Physical and medical rehabilitation, CHU Brest, Brest, France.
DOI: 10.2340/20030711-1000054

Abstract

The consequences and optimal treatment of quadriceps fibrosis following intramuscular quinine injection during childhood remain unclear. We report here a case of a 17-year-old girl who experienced unilateral quadriceps fibrosis following intramuscular injection of quinine as a baby. This case report describes the evolution of the condition during the child's growth, the long-term impact of early fibrosis on range of motion, muscle volumes, strength, gait, and activities of daily living. Rehabilitation involved orthoses and physiotherapy from the age of 6 years, when her knee flexion was reduced to 90°. A Judet quadricepsplasty was performed at 12 years because of continued loss of knee range with consequences for gait. At 16 years, knee range was satisfactory and gait variables were normalized. Functional evaluations and quality of life scales showed excellent recovery. Isometric strength of the involved quadriceps remained lower than the expected age-matched strength. Magnetic resonance imaging identified amyotrophy of the quadriceps, specifically the vastus intermedius. Despite being a focal impairment, quadriceps fibrosis had wider consequences within the involved limb, the uninvolved limb and functioning. This case report illustrates how children with quadriceps fibrosis can have a good prognosis, with excellent functional results at the end of the growth period, following early and appropriate management.

Lay Abstract

Children with malaria may be treated by a quinine injection into their quadriceps (thigh muscle). Unfortunately, this can cause fibrosis (scarring) inside the muscle. Fibrosis can prevent muscle growth, cause weakness and limit knee movement. The progression of the condition during growth is poorly documented and the best treatment methods are not known. We describe the case of a girl with quadriceps fibrosis. We explain the problems she had from the age of 6 to 17 years, and the treatment that she received. At the age of 6, she began rehabilitation, involving splints and physiotherapy. At the age of 12, she had surgery to lengthen her quadriceps and help her to bend her knee. By the time she was 16, her leg was much stronger, she had sufficient knee movement, and she could walk normally. Early and continued rehabilitation combined with surgery lead to successful results.

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