Gupta Anupam, Saurabh Suman, Trikha Tanya, Karpe Aashraya, Mittal Samarth
Department of Orthopaedics, All India Institute of Medical Sciences, JPNATC, AIIMS, New Delhi, India.
Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, India.
Indian J Orthop. 2022 Jun 29;56(8):1339-1346. doi: 10.1007/s43465-022-00683-8. eCollection 2022 Aug.
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.
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.
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.
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.
小儿麻痹后遗症（PPS）患者的股骨干骨折是一种罕见但复杂的损伤类型。软组织包膜发育不良、肌肉量减少、血管分布减少、局部骨质减少、关节挛缩以及骨骼解剖结构改变带来了重大的手术挑战。全面的术前规划至关重要，因为每个病例都需要个体化的治疗方法和固定方式。本研究的目的是分析此类患者骨折固定后的临床结果，评估所遇到的手术挑战并提供解决方案。
对33例PPS肢体股骨干骨折患者进行回顾性病例系列研究。记录损伤方式、固定方法、手术时间、术中失血、愈合时间和并发症。
低能量跌倒为最常见的损伤机制（73%）。33例患者接受了内固定治疗，其中髓内钉固定是最常见的方式（79%）。患者的股骨髓腔直径、股骨弓、骨折部位和形态以及临床畸形是决定植入物选择的关键因素。锁定钢板、预塑形解剖钢板和钛弹性髓内钉系统为不适合髓内钉固定的患者提供了替代方案。不同植入物之间无差异，平均骨愈合时间为13.8±4.4周。所有患者在术后6个月末恢复完全负重活动，并恢复到受伤前的活动状态。
通过详细的术前检查、考虑术中困难、制定个体化手术方案、谨慎处理软组织以及准备备用植入物，PPS患者股骨骨折可取得良好的临床效果。
