Choice of implants in management of fractures in patients with post-polio residual paralysis

Abstract

Introduction: Poliomyelitis is on the verge of eradication. Fractures in polio survivors present unique challenges; the bone is often small, deformed, osteoporotic and hypovascularized. Aim: Our aim was to assess the varied fracture patterns and the challenges faced in fixation of fractures in polio affected limbs and possible solutions to overcome them. Material & methods: All cases were managed at RMMCH, Annamalai University. Each and every case was unique in its own terms with variable clinical and radiological presentation. Varied challenges were managed in different manner with respect to implant choice for optimal outcome. Results: Fracture union and callus formation were evaluated on radiographs taken at each postoperative visit. Functional outcome assessments included range of motion and early return to activities of daily living. All fractures healed except for one nonunion due to conservative management. Conclusion: Anatomical locking plate may not be ideal for these patients as the plates may be larger and overhang the malformed bone. Hence nails with smaller diameter and locking compression plates designed for other skeletal regions may give better results than the conventional plates and nails. Fractures in the polio-affected limb are not a common entity and are difficult to manage using a common fracture management protocols and need to be customized for individual patients to suit their needs and bones with all implants ready for use.