Distal femoral fractures in post-poliomyelitis patients treated with locking compression plates

Abstract

Objective: Treatment of distal femoral fracture in post-polio patients is difficult because the bone is usually osteopenic, small and deformed. This retrospective study aimed to investigate the outcomes of distal femoral fracture in post-polio patients treated by locking compression plates (LCP).

Methods: The medical records of 19 post-polio patients (mean age 49 years at time of surgery) were reviewed and intraoperative data retrieved. Fracture union and callus formation were evaluated on radiographs taken at each postoperative visit. Functional outcome assessments included range of motion and Hospital for Special Surgery (HSS) score of the ipsilateral knee joint.

Results: Sixteen femoral fractures occurred in the poliomyelitis-affected limbs. The mean duration of operation was 86 min and mean blood loss 120 mL. All fractures healed (mean, four months) but union was delayed in one. At the final follow-up 2 yrs after surgery, the mean range of knee flexion was 105° (range, 90°-130°), and mean HSS score 76 points (range, 60-93). There were no cases of nonunion, implant cutout, or other complications.

Conclusions: LCP provides stable fixation of distal femoral fractures in post-polio patients. Bony union and good functional outcomes are achieved, but delayed union and minimal callus may occur.

Figure 1

Distal femoral fracture in a 50‐year‐old woman with post‐polio syndrome treated with an LCP. (a) Radiograph showing a type 32‐B1 fracture and osteopenia. (b, c) Postoperative radiographs showing fixation with an LCP with four unused plate holes at the fracture site. (d, e) Radiographs 5 months after surgery showing fracture union.

Figure 2

Type 33‐C1 fracture in patient with post‐polio syndrome. A 50‐year‐old man had from polio during childhood. Fracture of his distal femur occurred when he slipped and fell at home. (a, b) Anteroposterior and lateral radiographs showing a type 33‐C1 fracture. (c) Posterior view of three dimensional construction of the communicated fracture. (d, e) Postoperative radiographs of distal femur fracture fixed by LCP. (f, g) Radiographs 3 months after surgery showing bone callus on the medial side of the fracture.