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Technical aspects and complications in the surgical treatment of poliomyelitis-affected lower limb fractures.

Technical aspects and complications in the surgical treatment of poliomyelitis-affected lower limb fractures.
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Mingo-Robinet J, Alonso JA, Moreno-Barrero M, González-García L, Garcia-Virto V, Aguado HJ,


Mingo-Robinet J, Alonso JA, Moreno-Barrero M, González-García L, Garcia-Virto V, Aguado HJ, (click to view)

Mingo-Robinet J, Alonso JA, Moreno-Barrero M, González-García L, Garcia-Virto V, Aguado HJ,

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Revista espanola de cirugia ortopedica y traumatologia 2018 03 28() pii S1888-4415(18)30017-1
Abstract
OBJECTIVE
Post-polio patients present problems such as small and deformed bones, with narrow intramedullary canal and osteoporosis, affecting surgical treatment. The aim of this article is to describe the main preoperative and intraoperative complications of the surgical treatment of fractures in this population.

MATERIAL AND METHODS
A retrospective analysis was conducted between 1995 and 2014. Data obtained from the medical records included patient age, fracture pattern (AO/OTA), device used, technical aspects of the surgery that changed compared to a standard procedure, and the presence of intraoperative skeletal complications.

RESULTS
Sixty-four patients with 78 fractures were included in the study. Forty-seven percent of the fractures were at the proximal femur. The main complications of hip arthroplasty (14 patients) were absent hip abductors and intraoperative instability (3), bad cup fixation (3) and intraoperative periprosthetic fracture (2). The main problems of intramedullary nailing were due to a narrow canal and previous bone deformity. Main problems reported when plating included difficulty to fit a precontoured plate, and oversized hardware.

CONCLUSION
Given the large number of intraoperative complications, in preoperative planning we must include nails of small diameter and length, locking plates and external fixators, and, in the case of hip arthroplasty, long and thin stems and restrictive or dual mobility acetabular systems.

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