Fractures occurring in the femurs of polio affected limbs pose various challenges in their management since they have an altered anatomy. In this study, the bone geometry of femoral fractures in post-polio residual paralysis patients is analysed and compared with standard implants for proper implant selection to provide a stable fixation.
Materials and methods: A total of 20 femoral fractures in adult post-polio residual paralysis patients were included in this study and their bone geometry was assessed. Based on the bone geometry in each case, appropriate implants were used. The mean age was 41.6 years (Range 26 to 58 years). 9 cases out of the 20 required the use of non-standard implants, including a custom-made femoral nail, a humerus nail, proximal humerus LCP, proximal tibial LCP and a modular bipolar hemiarthroplasty prosthesis with DDH stem. Mean duration of follow up was 34.5 months (Range 2 to 5 years).
Results: The mean union time was 4.63 months. The mean duration of surgery was 81min (Range 65-145 mins). Intra-operative blood loss ranged from 80-250ml (Mean 130ml) with no case requiring blood transfusion. Mean hospital stay ranged from 7-9 days. All patients returned to their pre-operative function (assessed according to Vignos scale for lower extremities), except for two cases showing a deterioration of function post-operatively.
Conclusion: No implant is unique for surgical management of femur fractures in post-polio residual paralysis patients. Proper pre-operative evaluation and planning should be individualised for each case according to the measured femoral geometry. The best implant should be chosen and a wide array of implants should be made available during surgery to achieve good results.