PMC6727442_01
Pre-operative morbidity of the patient: (a) Inability to squat; (b) Restriction of flexion of both hips.
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F1
The parents had not sought care for the child initially and he was being managed conservatively with physiotherapy, but the child was not showing any improvement (Fig. 1a). Apart of flexion adduction and internal rotation was also restricted on both sides (Fig. 1b).
Pre-operative examination finding showing wasting and puckering in bilateral glutei.
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F2
There was atrophy and flattening of both glutei with left significantly more wasted than right (Fig. 2).
Radiological investigations: (a) X-ray shows no abnormality. (b) Magnetic resonance imaging shows marked atrophy of bilateral glutei (left> right) with low-intensity band within upper and middle 1/3rd of belly of the left gluteus maximus (encircled in b3).
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F3
There was no significant abnormality noted on plain radiograph (Fig. 3a). Mild medial retraction of distal body of the tendons of gluteus maximus was also noted (Fig. 3b).
Intraoperative finding showing the contracture band and sciatic nerve.
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F4
Sciatic nerve was identified and protected in both procedures (Fig. 4).
Post-operative follow-up at 1 year: (a) Hypertrophic scar at surgical site; (b, c) improved flexion in both hips; (d, e) extension of both hips possible; (f) child is able to sit cross-legged.
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F5
There was hypertrophic scar formation on both sides, for which he was advised treatment, but the parents refused for treatment (Fig. 5) (Video 2).