Repeated IM injections,especially at thigh cause fibrosis of quadriceps leading deficiency of flexion of knee. To be careful with adequate technique of injections and doses for children.

1. 21th ANNUAL CONFERENCE OF CAMBODIAN SOCIETY OF SURGERY
ABSTRACT
TREATMENT OF THE QUADRICEPS FIBROSIS AFTER INJECTIONS, ABOUT 200 CASES (141 PATIENTS),
TREATED AT NATIONAL PEDIATRIC HOSPITAL FROM 2009 TO 2015
HENG Sophea, SENG Seaklin, CHHOEURN Vuthy
Objectives: The purpose of this study is to analyze results of series of the patients with quadriceps fibrosis after intramuscular
injections who have been treated at the Pediatric Surgical Department of the National Pediatric Hospital, and to alert to health staffs
and physicians in order to know its complications and reduce drug usage in this way.
Materials and methods: This is a retrospective study of 141 children and adolescents (200 knees), diagnosed and treated between
January 2009 to October 2015. There were 56 males and 85 females. The age of the patients is ranged from 24 months to 22 years
(mean age 7 years). Of these 141 patients, 50 and 32 had affected the left and right knee respectively and other 59 patients affected
bilateral knee. The diagnosis of quadriceps fibrosis were done with history of repeated intramuscular injections in order to treat
varieties of symptoms and disease few years ago, physical examination where limping, muscle hypotrophy and limited knee flexion
of affected side (s). All of these 200 cases, treatment were conducted by surgical release and followed by early rehabilitation.
Results: The scoring system is used to evaluate the results by measure of the degree of knee flexion at the final follow-up. The result
was "Good" in 182 knee (91%), "Satisfactory" in 14 knee (7%), "Fair" in 4 knee (2%). Without treatment, the quadriceps fibrosis
caused a loss of knee flexion or retraction of extensor system, affecting walking function, sitting position and the growth of the lower
limb.
Conclusion: The quadriceps fibrosis after injections is a serious iatrogenic complication secondary to repeated intramuscular
injections. It could cause a stiffness of the knee in extension installing aesthetic and functional problem. The motor disability is a
veritable problem of public health. Surgical release including tenotomy and/or muscle lengthening followed by an early
rehabilitation remains the most effective method to restore the function of the knee. It is a public health issue and it is preventable.
We, therefore, recommend alternative systemic use of drug forms (oral, rectal and intravenous), instead of intramuscular injections,
to avoid such a long life iatrogenic impairment complications.
Key words: Quadriceps fibrosis; Intramuscular injections; Impairment, progressive limited flexion, surgical release, rehabilitation,
functional and cosmetic disturbance.
National Pediatric Hospital
Department of Surgery, 2015
N° 100, Blv. Russe Federation, TuolKork, Phnom Penh, Cambodia.