Congenital contracture of the iliotibial tract: a case report

Abstract

Introduction. Congenital contracture of the iliotibial tract is a rather rare pathology that causes difficulties in diagnosing and planning treatment activities. The lack of a clear idea of the causes of the disease has led to disagreement in the interpretation of the diagnosis in patients with this pathology. In the Russian-language literature, this disease is referred to as idiopathic extension and abduction contracture of a hip joint or idiopathic contracture of the dorsal gluteal muscle (a congenital contracture of the tendons of the dorsal gluteal muscles), whereas the English-language literature more often highlights congenital or idiopathic contracture of the dorsal gluteal muscles.
 Clinical сase. The results of treatment of a 6-year-old child with congenital contracture of the iliotibial tract is presented. The child exhibited lameness when walking first started, but the correct diagnosis was not established. Clinically, along with the limitation of adduction and extension in the hip joint and an induration of the soft tissue along the external surface of the right thigh, the pelvis was skewed, and there was shortening of the right lower limb and a valgus deformity of diaphysis of the right femoral bone. Ultrasonographic and magnetic resonance imaging indicated the presence of a fibrous bridle over the outer surface of the right thigh. The fibrous bridle was excised for 15 cm, and a temporary hemiepiphysiodesis of the medial portion of the distal growth zone of the right femur was performed.
 Results and discussion. At the 1-year control examination, the patient did not present any complaints. There was no relapse of the contracture. According to X-ray study results, correction of the valgus deformity of the right femur was achieved, and the metal structures were removed. Despite the more frequent extension and abduction direction of the contracture of the iliotibial tract indicated by most authors, the direction and severity apparently may depend on the predominant zone of fibrous degeneration of the muscle groups. Additionally, with the predominant lesion of the dorsal gluteal muscle, a more pronounced extension component can be expected, whereas with the predominant lesion of the musculus tensor fasciae latae, a flexion component can be expected and was observed in our patient.