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

## TL;DR

A 14-year-old girl with a muscle contracture caused by repeated injections underwent successful surgery and recovered fully with physical therapy.

## Contribution

This case report highlights the effectiveness of rectus femoris lengthening surgery for injection-induced contractures in children.

## Key findings

- Surgical lengthening of the rectus femoris using Z-plasty improved knee flexion and hip extension.
- Postoperative physiotherapy and early mobilization led to full recovery with no complications.
- Injection-induced contractures are common in children due to frequent thigh injections in Syria.

## Abstract

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.

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.

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.

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.

•Quadriceps Contracture muscle can be congenital or acquired.•Injection-induced rectus femoris contracture muscle is common in children due to thigh injections.•Quadriceps Contracture muscle Presents as knee stiffness with limited flexion, diagnosed via physical exams like Ely's test.•Z-plasty lengthening of rectus femoris muscle effectively increases muscle length, facilitating early mobility and reducing recurrence risk.•Healthcare providers should use methods other than intramuscular injection to administer medications.

Quadriceps Contracture muscle can be congenital or acquired.

Injection-induced rectus femoris contracture muscle is common in children due to thigh injections.

Quadriceps Contracture muscle Presents as knee stiffness with limited flexion, diagnosed via physical exams like Ely's test.

Z-plasty lengthening of rectus femoris muscle effectively increases muscle length, facilitating early mobility and reducing recurrence risk.

Healthcare providers should use methods other than intramuscular injection to administer medications.