Outcome of femoral fractures in poliomyelitis patients

Abstract

Background and purpose

As patients who were afflicted with poliomyelitis during the outbreaks in the past are aging, lower extremity osteoporotic fractures are becoming more frequent. Fixation in deformed, porotic bone, coupled with muscle weakness and imbalance creates a unique challenge when treating these fractures as does their reduced rehabilitation potential. The aim of this study was to investigate the outcome of femoral fractures in surviving poliomyelitis patients.

Patients and methods

Sixty-five patients with 74 femoral fractures were treated between 1990 and 2014. Clinical outcome was assessed using the Parkland and Palmer mobility score, and quality-of-life was assessed using the SF-12® score.

Results

Some 84% of the fractures were a result of low-energy mechanisms and occurred in the polio-affected limbs, but nonaffected limbs were also injured owing to low-energy mechanisms in all cases. Fifty-seven fractures were treated operatively. There were nine re-operations (16%), including implant removals, nonunion, peri-implant fractures, and malunion. Some 60% of the patients did not regain their previous ambulatory capacity. Post-operative weight-bearing status did not correlate with the final functional outcome.

Conclusions

Polio patients with femoral fractures have a guarded prognosis for regaining their pre-injury ambulatory capacity. A higher re-operation rate than that with “normal” osteoporotic fractures is expected.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Mohammad AF, Khan KA, Galvin L, Hardiman O, O’Connell PG (2009) High incidence of osteoporosis and fractures in an aging post-polio population. Eur Neurol 62:369–374. https://doi.org/10.1159/000242444

    Article  PubMed  Google Scholar 

  2. 2.

    Nam KY, Lee S, Yang EJ, Kim K, Jung S, Jang SH, Han SN, Kim WH, Lim JY (2016) Falls in Korean polio survivors: incidence, consequences, and risk factors. J Korean Med Sci 31:301–309. https://doi.org/10.3346/jkms.2016.31.2.301

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Cummings S, Melton L (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767. https://doi.org/10.1016/s0140-6736(02)08657-9

    Article  PubMed  Google Scholar 

  4. 4.

    Konda S, Pean C, Goch A, Fields A, Egol K (2015) Comparison of short-term outcomes of geriatric distal femur and femoral neck fractures. Geriatr Orthop Surg Rehabil 6:311–315. https://doi.org/10.1177/2151458515608225

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Lau J, Parker J, Hsu L, Leong J (1986) Paralytic hip instability in poliomyelitis. J Bone Joint Surg (Br) 68-B:528–533. https://doi.org/10.1302/0301-620x.68b4.3733824

    Article  Google Scholar 

  6. 6.

    Chang J, Fan J, Lam H, Cheung K, Chu V, Fung K (2009) Treatment of an osteoporotic Hoffa fracture. Knee Surg Sports Traumatol Arthrosc 18:784–786. https://doi.org/10.1007/s00167-009-0960-4

    Article  PubMed  Google Scholar 

  7. 7.

    El-Sayed Khalil A (2010) Locked plating for femoral fractures in polio patients. Arch Orthop Trauma Surg 130:1299–1304. https://doi.org/10.1007/s00402-010-1126-z

    Article  PubMed  Google Scholar 

  8. 8.

    Wang W, Shi H, Chen D, Chen Y, Wang J, Wang S, Qiu Y, Xiong J (2013) Distal femoral fractures in post-poliomyelitis patients treated with locking compression plates. Orthop Surg 5:118–123. https://doi.org/10.1111/os.12035

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Vaquero J, Munoz J, Prat S, Ramirez C, Aguado H, Moreno E, Perez M (2012) Proximal femoral nail antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study. Injury 43:S47–S54. https://doi.org/10.1016/s0020-1383(13)70179-7

    Article  PubMed  Google Scholar 

  10. 10.

    Lee D, Jo J, Jung J, Kim S (2014) Prognostic factors predicting early recovery of pre-fracture functional mobility in elderly patients with hip fracture. Ann Rehabil Med 38:827–835. https://doi.org/10.5535/arm.2014.38.6.827

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Leland N, Gozalo P, Christian T, Bynum J, Mor V, Wetle T, Teno J (2015) An examination of the first 30 days after patients are discharged to the community from hip fracture postacute care. Med Care 53:879–887. https://doi.org/10.1097/mlr.0000000000000419

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

YNG and YAW designed the study, supported data collection, performed data analyses, and wrote and revised the manuscript. AK, ML, and RM designed the study, operated the patients, and critically reviewed the manuscript.

Corresponding author

Correspondence to Yechiel N. Gellman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

An IRB (institutional Review Board) approval was obtained for this study according to the 1964 Helsinki Declaration.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gellman, Y.N., Khoury, A., Liebergall, M. et al. Outcome of femoral fractures in poliomyelitis patients. International Orthopaedics (SICOT) 43, 2607–2612 (2019). https://doi.org/10.1007/s00264-019-04285-2

Download citation

Keywords

  • Poliomyelitis
  • Osteoporotic fractures
  • Femoral fractures