A 24-year-old rugby player suffered a direct blow to the anterior thigh ('dead leg') three weeks ago. His coach applied vigorous deep tissue massage and hot packs daily, and he returned to play within four days. He now has progressive thigh stiffness and swelling. Radiographs show a fusiform area of calcification within the quadriceps, separated from the underlying femur by a clear radiolucent zone, with mature bone at the periphery. The most likely diagnosis is:

• A Myositis ossificans traumatica ✓
• B Parosteal osteosarcoma
• C Calcific haematoma of the vastus intermedius
• D Periosteal chondrosarcoma

Explanation

Myositis ossificans traumatica follows a severe quadriceps contusion and is promoted by early massage, heat, forced passive stretching and premature return to sport. Radiographically it appears as a fusiform soft tissue ossification separated from bone by a lucent cleft, maturing from the periphery inwards (zone phenomenon). This peripheral maturation distinguishes it from parosteal osteosarcoma, where the immature tissue lies centrally against the cortex. Initial treatment of a dead leg is rest, ice, compression and brief immobilization in knee flexion.

Reference: Apley's System of Orthopaedics and Fractures, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.