Pertrochanteric Femur Fracture in a Post-Polio Patient treated with a Pediatric Hip Plate: A Case Report.

Abstract

Introduction: Fracture fixation in post-polio residual paralysis is technically demanding due to dysplastic proximal femoral anatomy, osteopenia, and distorted trochanteric morphology. Standard cephalomedullary nailing may be impossible when the medullary canal is narrow, or the entry point is malpositioned.

Case report: A 45-year-old man with childhood poliomyelitis and complete paralysis of the right leg sustained an AO 31-A1.2 pertrochanteric fracture. Radiographs revealed coxa valga and a markedly narrow canal, precluding safe cephalomedullary nailing. Closed reduction on a traction table required 35° internal rotation to achieve anatomical alignment. Fixation was performed with a Synthes Pediatric Hip Plate (120°, four-hole, 5.0 mm) through a lateral trans-muscular approach. The intraoperative course was uneventful. Postoperatively, partial weight bearing in the orthosis was initiated; radiographs confirmed stable reduction. At 6-week follow-up, the patient reported minimal pain, which subsequently resolved completely. By 3-month follow-up, radiographs demonstrated progressive but incomplete bony consolidation, with stable implant position and no evidence of implant loosening or loss of reduction.

Conclusion: In adults with post-polio femoral dysplasia and canal stenosis, a pediatric LCP hip plate can provide a low-profile, angular-stable alternative when intramedullary fixation is anatomically contraindicated.