Journal of Orthopedics and Joint Surgery

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VOLUME 2 , ISSUE 1 ( January-June, 2020 ) > List of Articles

Original Article

A Study of Surgical Intervention in Fractures of Post-polio Residual Paralytic Lower Limb, Challenges Encountered, and Outcome Analysis

Prahalad Kumar Singhi, Vinoth Thangamani

Citation Information : Singhi PK, Thangamani V. A Study of Surgical Intervention in Fractures of Post-polio Residual Paralytic Lower Limb, Challenges Encountered, and Outcome Analysis. 2020; 2 (1):10-16.

DOI: 10.5005/jp-journals-10079-1019

License: CC BY-NC 4.0

Published Online: 17-10-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Introduction: India is now a polio-free nation, but a huge load of ambulatory polio survivors present with challenging deformities and fractures to the present generation of orthopedic surgeons. These fractures are more challenging, because of the paralyzed, contracted shaft of femur fracture tissues, and inappropriate muscle forces, causing deformities. Also hypoplastic, osteoporotic, and less vascularized bone will influence the reduction maneuver, implant selection, fracture healing, and final outcome. We assess the outcome of surgical management of femoral and tibial fractures in the post-polio residual paralytic limb and the challenges encountered. Materials and methods: Out of 22 cases with 23 fractures analyzed, 2 cases were lost to follow-up and hence excluded and the remaining 20 patients were analyzed. Pre-injury deformity, range of movement, mode of ambulation (Vignos scoring), mode of injury, surgical technique, rehabilitation, and outcomes were assessed. Results: Minimum follow-up duration was 30 months; union was achieved by 18–24 weeks. We had one delayed union and one nonunion, which were managed with bone grafting. None of our patients had infection. A total of 16 patients regained their prefracture mobility; 4 patients developed hand to knee gait due to further weakness of the quadriceps muscle. Conclusion: In our series, femur was the most commonly fractured bone among the post-polio residual paralytic limbs. Fractures don't heel as readily as in normal bone. Conservative treatment has guarded prognosis. Decision of surgical treatment will be challenging. Pre-injury state, surgical planning, technique, and implant choice will be key factors with appropriate rehabilitation to have a satisfactory outcome.

  1. Surviving polio in a post polio world. Soc Sci Med 2014;107:171–178. DOI: 10.1016/j.socscimed.2014.02.024.
  2. Osteoporosis in a postpolio clinic population. Arch Phys Med Rehabil 2007;88(8):1030–1035. DOI: 10.1016/j.apmr.2007.05.010.
  3. Functional outcome after lengthening with and without deformity correction in polio patients. Int Orthop (SICOT) 2008;32(3):403–407. DOI: 10.1007/s00264-007-0322-0.
  4. After eradication: India's post-polio problem. BMJ 2014;348:g2275. DOI: 10.1136/bmj.g2275.
  5. Circumstances and consequences of falls in polio survivors. J Rehabil Med 2010;42(10):908–915. DOI: 10.2340/16501977-0620.
  6. Poliomyelitis: Orthopedic management. Curr Orthop 2006;20:41–46. DOI: 10.1016/j.cuor.2005.10.005.
  7. Early and late losses of motor units after poliomyelitis. Brain 1997;120(8):1415–1421. DOI: 10.1093/brain/120.8.1415.
  8. Osteoporosis in neurological disorders. J Neurol Neurosurg Psychiatry 2000;68(5):543–547. DOI: 10.1136/jnnp.68.5.543.
  9. Response of postpoliomyelitis patients to bisphosphonate treatment. PMR 2010;2(12):1094–1103. DOI: 10.1016/j.pmrj.2010.08.009.
  10. Late effects of poliomyelitis - a review of capacity. S Afr Med J 1990;77(11):575–576.
  11. Paralytic deformities of the lower limb. Int Orthop (SICOT) 1984;8(2):147–154. DOI: 10.1007/BF00265836.
  12. Maintenance of ambulation in childhood muscular dystrophy. J Chronic Dis 1960;12(2):273–290. DOI: 10.1016/0021-9681(60)90105-3.
  13. Locked plating for femoral fractures in polio patients. Arch Orthop Trauma Surg 2010;130(10):1299–1304. DOI: 10.1007/s00402-010-1126-z.
  14. Difficulty in fixation of fracture neck of femur in a paralytic hip: a case report. J Evol Med Dent Sci 2014;3(30):8484–8489. DOI: 10.14260/jemds/2014/3074.
  15. Comprehensive review of challenges associated with management of lower limb fractures in poliomyelitis patients. J Clin Orthop Trauma 2016;7(4):276–281. DOI: 10.1016/j.jcot.2016.08.007.
  16. Supracondylar femoral extension osteotomies in the treatment of fixed flexion deformity of the knee. Clin Orthop Relat Res 1982(171):87–93. DOI: 10.1097/00003086-198211000-00015.
  17. Assessment of bone geometry and its considerations in implant selection for polio affected femoral fractures: An outcome analysis. Int J Orthod Sci 2017;3(1):441–448. DOI: 10.22271/ortho.2017.v3.i1f.65.
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