A 19-year-old footballer sustains a direct blow to the anterior thigh. X-ray excludes fracture. He is started on aggressive passive stretching of the quadriceps from day 2. Three weeks later he has a firm, tender mass in the thigh with progressive restriction of knee flexion. The most likely diagnosis and the error in management are:
- A Osteosarcoma; biopsy should have been done at presentation
- B Myositis ossificans traumatica; premature passive stretching aggravated heterotopic bone formation ✓
- C Haematoma; inadequate compression bandage allowed expansion
- D Compartment syndrome; fasciotomy was missed
Correct answer: B. Myositis ossificans traumatica; premature passive stretching aggravated heterotopic bone formation
Explanation
Severe quadriceps contusion followed by forceful passive stretching is a classic trigger for myositis ossificans traumatica, where heterotopic bone forms within the muscle. Early passive stretching and massage worsen it; management is rest, ice, gentle active range of motion once acute pain settles, and NSAIDs in selected cases. The mass matures over months and may resorb partially. Osteosarcoma is less likely given clear trauma history and location within muscle.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.