Strategies in the management of femoral fractures in post-polio limb a retrospective analysis of 10 patients with 3-year follow-up

Abstract
Background: Out of 10–20 million people in the world with post-polio sequelae, around 6.5 million of them are in India. Due to its eradication, survivors have lived through their life and crossed 40–50 years of age. Falls and subsequent fractures are common in these patients, which are difficult to manage and cause considerable morbidity. We conducted this study to analyze the various strategies used in the management of fractures in a post-polio limb. Methods: This is a retrospective study analyzing a total of 10 adult patients with post-polio sequelae
complicating the fractured limb which was managed with varied treatment options such as locking compression plate, dynamic hip screw, and hemiarthroplasty. The functional status of the patient was evaluated with Vignos grade of disability.
Results: All the patients (mean age of 34 ±12 years ) were treated with extramedullary internal fixation devices such as locking compression plating in 6 patients, dynamic hip screw fixation in 1 patient, cancellous screw fixation in 2 patients, and total hip replacement in one patient. Of the 10 cases, 8 were
fresh fractures, and 2 presented with a failed fixation for repeated fracture sustained later on. The mean follow-up period was 37.8 ±16.4 months. Bony union was attained at a mean duration of 3.5 ±1.4 months in all the patients undergoing fracture fixation. None of the included had secondary implant failure or other complications. Conclusion: Patients with limbs involving post-polio sequelae are more prone to fractures and are difficult to manage using the standard treatment protocols. Extramedullary internal fixation device provides effective stability for bony union and optimal functional results without major complications in these small, deformed, osteoporotic, and hypo-vascularized femurs.