Skip to main content

Advertisement

SpringerLink
Log in

Femoral Shaft Fracture in Post-polio Syndrome Patients: Case Series from a Level-I Trauma Center and Review of Literature

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

An Author Correction to this article was published on 29 November 2022

This article has been updated

Abstract

Background

Femoral shaft fracture in patients of post-polio syndrome (PPS) represents an uncommon yet complex injury pattern. Poorly developed soft-tissue envelope, decreased muscle bulk, reduced vascularity, regional osteopenia, joint contractures, and altered bony anatomy impose significant surgical challenges. Thorough pre-operative planning is imperative as each case requires individualized approach and method of fixation. The aim of the study was to analyze the clinical outcomes in such patients following fracture fixation and to assess the surgical challenges encountered and provide solutions.

Materials and Methods

A retrospective case series of 33 patients with femoral shaft fracture in PPS limbs was undertaken. Mode of injury, method of fixation, surgical time, intra-operative blood loss, union time, and complications were recorded.

Results

Low-energy fall was the most common mechanism of injury (73%). Thirty-three patients underwent fixation with intramedullary nailing being the most common mode (79%). Femoral canal diameter, femoral bow, fracture location and morphology and clinical deformities of the patients are key governing factors that determine the choice of implant. Locking plates, pre-contoured anatomical plates, and titanium elastic nailing system offer an alternative in patients unsuitable for nailing. With no difference between various implants, average time for bone healing was 13.8 ± 4.4 weeks. All patients resumed full weight-bearing mobilization and returned to pre-injury activity status at the end of 6 months post-surgery.

Conclusion

With detailed pre-operative work-up, contemplating intra-operative difficulties, individualized surgical plan, careful handling of soft tissues, and availability of back-up implants, good clinical outcomes can be achieved in femur fractures in PPS patients.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Change history

References

  1. Trojan, D. A., & Cashman, N. R. (2005). Post-poliomyelitis syndrome. Muscle and Nerve, 31(1), 6–19.

    Article  PubMed  Google Scholar 

  2. Poliomyelitis (polio) [Internet]. [cited 2021 Jun 26]. https://www.who.int/westernpacific/health-topics/poliomyelitis. Accessed 26 June 2021

  3. Tiffreau, V., Rapin, A., Serafi, R., Percebois-Macadré, L., Supper, C., Jolly, D., & Boyer, F. C. (2010). Post-polio syndrome and rehabilitation. Annals of Physical and Rehabilitation Medicine, 53(1), 42–50. https://doi.org/10.1016/j.rehab.2009.11.007.

    Article  PubMed  CAS  Google Scholar 

  4. Haziza, M., Kremer, R., Benedetti, A., & Trojan, D. A. (2007). Osteoporosis in a postpolio clinic population. Archives of Physical Medicine and Rehabilitation, 88(8), 1030–1035.

    Article  PubMed  Google Scholar 

  5. Silver, J. K., & Aiello, D. D. (2002). Polio survivors: Falls and subsequent injuries. American Journal of Physical Medicine and Rehabilitation, 81(8), 567–570.

    Article  PubMed  Google Scholar 

  6. Mohammad, A. F., Khan, K. A., Galvin, L., Hardiman, O., & O’Connell, P. G. (2009). High incidence of osteoporosis and fractures in an aging post-polio population. European Neurology, 62(6), 369–374.

    Article  PubMed  Google Scholar 

  7. Goerss, J. B., Atkinson, E. J., Windebank, A. J., O’Fallon, W. M., & Melton, L. J. (1994). Fractures in an aging population of poliomyelitis survivors: A community-based study in Olmsted County. Minnesota. Mayo Clin Proc., 69(4), 333–339.

    Article  PubMed  CAS  Google Scholar 

  8. Mingo-Robinet, J., Alonso, J. A., Moreno-Barrero, M., González-García, L., Garcia-Virto, V., & Aguado, H. J. (2018). Aspectos técnicos y complicaciones en el tratamiento de las fracturas de los miembros inferiores con secuelas de poliomielitis. Rev Esp Cir Ortopédica Traumatol., 62(4), 257–266.

    CAS  Google Scholar 

  9. Wang, W., Shi, H., Chen, D., Chen, Y., Wang, J., Wang, S., et al. (2013). Distal femoral fractures in post-poliomyelitis patients treated with locking compression plates. Orthopaedic Surgery, 5(2), 118–123.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mehndiratta, M. M., Mehndiratta, P., & Pande, R. (2014). Poliomyelitis. The Neurohospitalist., 4(4), 223–229.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gonzalez, H., Khademi, M., Borg, K., & Olsson, T. (2012). Intravenous immunoglobulin treatment of the post-polio syndrome: Sustained effects on quality of life variables and cytokine expression after one year follow up. Journal of Neuroinflammation, 9(9), 167.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Gellman, Y. N., Khoury, A., Liebergall, M., Mosheiff, R., & Weil, Y. A. (2019). Outcome of femoral fractures in poliomyelitis patients. International Orthopaedics, 43(11), 2607–2612.

    Article  PubMed  Google Scholar 

  13. Hill, K. D., & Stinson, A. T. (2004). A pilot study of falls, fear of falling, activity levels and fall prevention actions in older people with polio. Aging Clinical and Experimental Research, 16(2), 126–131.

    Article  PubMed  Google Scholar 

  14. Bickerstaffe, A., Beelen, A., & Nollet, F. (2010). Circumstances and consequences of falls in polio survivors. Journal of Rehabilitation Medicine, 42(10), 908–915.

    Article  PubMed  Google Scholar 

  15. Brogårdh, C., & Lexell, J. (2014). Falls, fear of falling, self-reported impairments, and walking limitations in persons with late effects of polio. PM & R: The Journal of Injury, Function, and Rehabilitation, 6(10), 900–907.

    Article  Google Scholar 

  16. Khallaf, F. G. M., Al-Rowaih, A., & Abdul-Hamid, H. F. (1998). Results of subtrochanteric fractures treated with dynamic hip screw and dynamic condylar screw. Medical Principles and Practice, 7(4), 283–291.

    Article  Google Scholar 

  17. Çevik HB. Management of femoral fractures in aging adult polio population: A retrospective review of 13 cases. South Clin Istanb Eurasia [Internet]. 2020 [cited 2021 Jul 6]. http://www.scie.online/jvi.aspx?un=SCIE-95967. Accessed 21 Aug 2019

  18. Park, H., & Kim, H. W. (2012). Treatment of femoral shaft fracture with an interlocking humeral nail in older children and adolescents. Yonsei Medical Journal, 53(2), 408–415.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee, K.J., Min, B.W., Jung, J.H., Kang, M.K., Kim, M.J. (2015) Expert tibia nail for subtrochanteric femoral fracture to prevent thermal injury. International Journal of Surgery Case Reports, 10, 158–61.

  20. El-Sayed, K. A. (2010). Locked plating for femoral fractures in polio patients. Archives of Orthopaedic and Trauma Surgery, 130(10), 1299–1304.

    Article  Google Scholar 

  21. Gupta, M., Jain, V. K., Upadhyaya, G. K., & Arya, R. K. (2016). Comprehensive review of challenges associated with management of lower limb fractures in poliomyelitis patients. Journal of Clinical Orthopaedics and Trauma, 7(4), 276–281.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Krupp, R. J., Malkani, A. L., Goodin, R. A., & Voor, M. J. (2003). Optimal entry point for retrograde femoral nailing. Journal of Orthopaedic Trauma, 17(2), 100–105.

    Article  PubMed  Google Scholar 

  23. Pettett, B. J., Avery, M. C., & Ostrum, R. F. (2017). Retrograde femoral nailing using percutaneous reduction techniques. Journal of Orthopaedic Trauma, 31, S6.

    Article  PubMed  Google Scholar 

  24. Assessment of bone geometry and its considerations in implant selection for polio affected femoral fractures: An outcome analysis [Internet]. ResearchGate. [cited 2019 Jan 19]. https://www.researchgate.net/publication/316019975_Assessment_of_bone_geometry_and_its_considerations_in_implant_selection_for_polio_affected_femoral_fractures_An_outcome_analysis. Accessed 6 Dec 2016

  25. Alvarez, A., Kremer, R., Weiss, D. R., Benedetti, A., Haziza, M., & Trojan, D. A. (2010). Response of postpoliomyelitis patients to bisphosphonate treatment. PM&R., 2(12), 1094–1103.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, JPNATC, AIIMS, New Delhi, India

    Anupam Gupta, Suman Saurabh & Samarth Mittal

  2. Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, India

    Tanya Trikha

  3. Shroff Eye Hospital, New Delhi, India

    Aashraya Karpe

Authors
  1. Anupam Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suman Saurabh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tanya Trikha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aashraya Karpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Samarth Mittal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samarth Mittal.

Ethics declarations

Conflict of Interest

The authors (Suman Saurabh, Anupam Gupta, Tanya Trikha, Aashraya Karpe, and Samarth Mittal) declare that they have no conflict of interests. Authors also declare that no funding has been received from any source.

Ethical approval

All procedures performed in study were in accordance with the ethical standards of the institutional guidelines and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants involved in the study.

Additional information

Publisher's Note

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

The original online version of this article was revised: It was erroneously stated in the Introduction that “Poliovirus predominantly affects the dorsal root ganglion …”.

The correct statement is: “Poliovirus predominantly affects the anterior horn cells …” [3].

References

3. Tiffreau V, Rapin A, Serafi R, Percebois-Macadré L, Supper C, Jolly D, Boyer FC. Post-polio syndrome and rehabilitation. Ann Phys Rehabil Med. 2010 Feb;53(1):42-50. doi: https://doi.org/10.1016/j.rehab.2009.11.007. Epub 2009 Dec 30. PMID: 20044320.

The original article has been corrected.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gupta, A., Saurabh, S., Trikha, T. et al. Femoral Shaft Fracture in Post-polio Syndrome Patients: Case Series from a Level-I Trauma Center and Review of Literature. JOIO 56, 1339–1346 (2022). https://doi.org/10.1007/s43465-022-00683-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-022-00683-8

Keywords

Search

Navigation