Polio revisited: reviving knowledge and skills to meet the challenge of resurgence

Abstract

Purpose: To date, polio has not been eradicated and there appears to be a resurgence of the disease. Hence, there is a need to revive decision-making skills to treat the effects of polio.

Methods: Here, we outline the aspects of treatment of paralysis following polio based on the literature and personal experience of the authors. The surgical treatment of the lower and upper extremities and the spine have been reviewed. The scope of bracing of the lower limb has been defined.

Results: The effects of polio can be mitigated by judicious correction of deformities, restoration of muscle balance, stabilising unstable joints and compensating for limb length inequality.

Conclusions: As polio has not been eradicated and there is a risk of resurgence of the disease, paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques for managing the effects of paralysis following polio is needed.

Keywords: Bracing; Paralytic deformity; Poliomyelitis; Resurgence; Surgical decision-making.

Fig. 1

Pelvic obliquity due to an abduction contracture of one hip can result in dislocation of the opposite hip

Fig. 2

Hand-to-thigh gait adopted by a boy who has paralysis of his left quadriceps femoris muscle

Fig. 3

A young boy (a) and an adolescent (b) with severe genu recurvatum

Fig. 4

Skeletal traction for severe fixed flexion deformity of the knee should include anterior traction on the proximal tibia to prevent posterior subluxation of the knee along with longitudinal traction to correct the flexion deformity

Fig. 5

An equino-cavo-varus deformity in an adolescent with polio. The equinus (a), cavus (b) and the hind foot varus (c) components of the deformity are clearly seen

Fig. 6

The location of tendons in relation to axes of the ankle joint (AA′) and the subtalar joint (STST′) are shown. All tendons located anterior to the axis of the ankle are ankle dorsiflexors (top-middle) while all tendons located posterior to the axis of the ankle are plantarflexors (top-right). All tendons located medial to the subtalar axis are invertors (bottom-middle) while all tendons located lateral to the subtalar axis are evertors (bottom-right). The greater the perpendicular distance of these tendons from the respective axis, the greater is their force moment

Fig. 7

Loss of muscle balance across the joint axis can result in a deformity. Restoration of muscle balance by an appropriate tendon transfer can correct the deformity

Fig. 8

Manual muscle testing of power of ankle dorsiflexors (a) and the invertors (b)

Fig. 9

Wedges resected from the talus and calcaneum during triple fusion for equino-cavus (above) and calcaneus (below)

Fig. 10

Varus deformity of the ankle, acquired ball-and-socket ankle, degenerative arthritis and varus instability developed 25 years after a triple fusion was performed to correct a varus deformity at the subtalar level in an adolescent. The underlying muscle imbalance was not corrected at the time of surgery

Fig. 11

Active abduction of the shoulder (a) which enables a girl to tie her hair (b) is possible after arthrodesis of a flail shoulder (c)

Fig. 12

Poor opposition of thumb in a child with paralysis of the opponens pollicis following polio (left) and pulp-to-pulp opposition restored after opponensplasty with flexor digitorum superficialis transfer (right)