Difficulty in Fixation of Fracture Neck of Femur in a Paralytic Hip: A Case Report

Babu, S. Suresh; Babu, Tummala Venkata Suresh; Kiran, Kopuri Ravi; Sudhakar, G.; Sridevi, M.

doi:10.14260/jemds/2014/3074

Cited by 2 publications

(1 citation statement)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Proximal femur fractures where regional osteopenia is most commonly seen and with small, valgoid, anteverted femoral neck there is greater risk of difficult reduction, nonunion, and implants failure. 14 When dynamic hip screw or cannulated cancellous screw fixation is not possible, proximal femur locking plates or rarely external fixators may be useful. Nonunion is very difficult to manage.…”

Section: Discussionmentioning

confidence: 99%

A Study of Surgical Intervention in Fractures of Post-polio Residual Paralytic Lower Limb, Challenges Encountered, and Outcome Analysis

Raju¹,

Singhi²,

Thangamani³

et al. 2020

Journal of Orthopedics and Joint Surgery

View full text Add to dashboard Cite

Introduction:India is now a polio-free nation, but a huge load of ambulatory polio survivors present with challenging deformities and fractures to the present generation of orthopedic surgeons. These fractures are more challenging, because of the paralyzed, contracted shaft of femur fracture tissues, and inappropriate muscle forces, causing deformities. Also hypoplastic, osteoporotic, and less vascularized bone will influence the reduction maneuver, implant selection, fracture healing, and final outcome. We assess the outcome of surgical management of femoral and tibial fractures in the post-polio residual paralytic limb and the challenges encountered. Materials and methods: Out of 22 cases with 23 fractures analyzed, 2 cases were lost to follow-up and hence excluded and the remaining 20 patients were analyzed. Pre-injury deformity, range of movement, mode of ambulation (Vignos scoring), mode of injury, surgical technique, rehabilitation, and outcomes were assessed. Results: Minimum follow-up duration was 30 months; union was achieved by 18-24 weeks. We had one delayed union and one nonunion, which were managed with bone grafting. None of our patients had infection. A total of 16 patients regained their prefracture mobility; 4 patients developed hand to knee gait due to further weakness of the quadriceps muscle. Conclusion:In our series, femur was the most commonly fractured bone among the post-polio residual paralytic limbs. Fractures don't heel as readily as in normal bone. Conservative treatment has guarded prognosis. Decision of surgical treatment will be challenging. Pre-injury state, surgical planning, technique, and implant choice will be key factors with appropriate rehabilitation to have a satisfactory outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

A Study of Surgical Intervention in Fractures of Post-polio Residual Paralytic Lower Limb, Challenges Encountered, and Outcome Analysis

Raju¹,

Singhi²,

Thangamani³

et al. 2020

Journal of Orthopedics and Joint Surgery

View full text Add to dashboard Cite

show abstract

Management Options and Outcomes for Patients with Femoral Fractures with Post-Polio Syndrome of the Lower Extremity

et al. 2020

View full text Add to dashboard Cite

» Post-polio syndrome is characterized by a late functional deterioration (usually after ≥15 years from the initial infection) in patients with a history of paralytic poliomyelitis infection, and it is defined by the March of Dimes criteria.» Patients with post-polio syndrome are at increased risk for falls and associated hip and femoral fractures as a result of lower bone mineral density, decreased lean muscle mass, and musculoskeletal deformities.» Current evidence suggests that treatment modalities for femoral fractures should emphasize fixation that allows early progressive weight-bearing and ambulation to optimize functional outcomes.» Good results after hip arthroplasty have been described with both cemented and uncemented implants in patients who have been treated for osteoarthritis, but there has been little evidence guiding hip fracture management. Anatomic challenges that are encountered are osteoporotic bone, a valgus neck-shaft angle, increased femoral anteversion, and a small femoral canal diameter.» Intramedullary nailing of hip and femoral fractures can be challenging due to the small femoral canal diameter that frequently is encountered. Alternative methods of fixation have shown promising results. These include the use of sliding hip screws for hip fracture management and fixed-angle locking plates for hip and femoral fracture management.

show abstract

Difficulty in Fixation of Fracture Neck of Femur in a Paralytic Hip: A Case Report

Cited by 2 publications

References 7 publications

A Study of Surgical Intervention in Fractures of Post-polio Residual Paralytic Lower Limb, Challenges Encountered, and Outcome Analysis

A Study of Surgical Intervention in Fractures of Post-polio Residual Paralytic Lower Limb, Challenges Encountered, and Outcome Analysis

Management Options and Outcomes for Patients with Femoral Fractures with Post-Polio Syndrome of the Lower Extremity

Contact Info

Product

Resources

About