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

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.

Keywords: Femur shaft fracture; Intramedullary nailing; PPS; Post-polio syndrome.

Fig. 1

30-Year-old male suffered fall from > 15 feet height. a, b Pre-op radiograph demonstrates mid-shaft femur fracture. CRIF with AFN was done. c–e Immediate post-op radiographs depicting anatomic reduction and satisfactory implant placement. f, g 3-Month post-op X-ray depicts bony union

Fig. 2

53-year-old female suffered fall from standing height and sustained a a–c right distal femoral shaft fracture. CRIF with DFN was done. d–f Post-op 6 month X-rays demonstrate complete bony union. Diffuse regional osteoporosis in femoral bone compared to healthy side

Fig. 3

36-Year-old male suffered from RTA. a, b Pre-op radiograph demonstrates subtrochanteric femoral fracture. ORIF with opposite side reverse DFLP done due to narrow femoral canal diameter. c, d 3-Month post-op X-ray depicts union; e–g follow-up 6-month X-rays demonstrating complete bony union. h Clinical photograph depicting resumption of full weight-bearing mobilization

Fig. 4

Antegrade femoral nail cut from distal dynamic locking hole to achieve the length of 300 mm

Fig. 5

a Antegrade femoral nail bent using a bench press bender. b Note the difference in sagittal profile of the bent nail compared to the standard available femoral nail