Key result
Low-energy falls cause ~79% of post-polio lower limb fractures, carrying notable operative complication risks.
Why the study?
Comprehensive evidence on fracture patterns, treatment, and outcomes in patients with post-polio residual paralysis who sustain lower limb fractures is limited.
What are the patterns, mechanisms, management, and outcomes of lower limb fractures in patients with post-polio residual paralysis?
What are the patterns, mechanisms, management, and outcomes of lower limb fractures in patients with post-polio residual paralysis?
Lower limb fractures in patients with post-polio residual paralysis predominantly involve the femur due to low-energy falls, and while operative management is common, it carries notable risks of nonunion and infection.
Warrants surgical caution and enhanced perioperative care in post-polio patients; extends prior observational data but leaves optimal fracture management open.
Poliomyelitis can cause long-term neuromuscular deficits, predisposing survivors to lower limb fractures. Altered biomechanics, muscle weakness, and osteopenia complicate management, yet comprehensive evidence on fracture patterns, treatment, and outcomes is limited. To systematically review lower limb fractures in patients with post-polio residual paralysis (PPRP), analyzing epidemiology, mechanisms of injury, management strategies, complications, and functional outcomes. A systematic search of PubMed, Embase, and Scopus (PROSPERO: CRD420251180231) identified cohort studies, case series, and case reports reporting lower limb fractures in PPRP patients. Data on demographics, fracture characteristics, management, complications, and functional recovery were extracted. Pooled analyses were performed for low-energy falls and nonunion rates using a random-effects model. Study quality was assessed with the Newcastle–Ottawa Scale and Joanna Briggs Institute checklist. Twenty-two studies reporting 443 lower limb fractures were included. Femoral fractures, particularly femoral neck fractures, predominated (33%). Low-energy falls accounted for 79% of injuries (95% CI 0.70–0.87). Operative management was performed in 72.5% of the lower limb fractures, and conservative management was used in 27.25%. Nonunion occurred in 8% of these fractures (95% CI 0.03–0.14), postoperative infection in 12% (95% CI 0–0.39), and revision surgery was required in 17% (95% CI 0.08–0.29). Modified surgical techniques generally achieved stable union, and structured rehabilitation with orthotic support facilitated functional recovery. Management was often challenged by deformities, osteopaenia, and altered anatomy. Lower limb fractures in PPRP predominantly involve the femur and result from low-energy falls. Operative management is common. Despite heterogeneity and study limitations, these findings provide clinically useful guidance and highlight the need for further research. PROSPERO ID: CRD420251180231.
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Regmi et al. (2026) studied this question. Lower limb fractures in post-polio paralysis patients mainly involve the femur (33%) and result from low-energy falls (79%); operative treatment leads to 8% nonunion and 12% infection rates.
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