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BMC Musculoskelet Disord. 2018 Sep 24;19(1):343. doi: 10.1186/s12891-018-2254-9.

Burden of gluteal fibrosis and post-injection paralysis in the children of Kumi District in Uganda.

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Harvard Combined Orthopaedic Surgery Residency Program, Boston, MA, USA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Department of Orthopaedic Surgery, University of British Colombia, Victoria, Canada.
Kumi Orthopaedic Center, Kumi, Uganda.
Kumi Hospital, Kumi, Uganda.
Makerere University School of Public Health, Kampala, Uganda.
University of California San Francisco Department of Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, 747 52nd Street, OPC 1st Floor, Oakland, CA, 94609, USA.



The purpose of this study was to estimate the prevalence of postinjection paralysis (PIP) and gluteal fibrosis (GF) among children treated in a rural Ugandan Hospital.


We conducted a retrospective cohort study by reviewing the musculoskeletal clinic and community outreach logs for children (age < 18 yrs) diagnosed with either PIP or GF from Kumi Hospital in Kumi, Uganda between 2013 and 2015. We estimated the prevalence as a ratio of the number of children seen with each disorder over the total population of children seen for any musculoskeletal complaint in musculoskeletal clinic and total population of children seen for any medical complaint in the outreach clinic.


Of 1513 children seen in the musculoskeletal clinic, 331 (21.9% (95% CI 19.8-24.1%)) had PIP and another 258 (17.1% (95% CI 15.2-19.0%)) had GF as their diagnosis. Of 3339 children seen during outreach for any medical complaint, 283 (8.5% (95% CI 7.6-9.5%)) had PIP and another 1114 (33.4% (95% CI 31.8-35.0%)) had GF. Of patients with GF, 53.9% were male with a median age of 10 years (50% between 7 and 12 years old). Of patients with PIP, 56.7% were male with a median age of 5 years (50% between 2 and 8 years old).


PIP and GF comprise over 30% of clinical visits for musculoskeletal conditions and 40% of outreach visits for any medical complaint in this area of Uganda. The high estimated prevalence in these populations suggest a critical need for research, treatment, and prevention.


Gluteal fibrosis; Post-injection paralysis

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