Aim– The polio is being eradicated very effectively, but post polio deformity will remain and need to be addressed by orthopaedic surgeons.The aim was to decrease the level of energies spent during walking by these patients and to make them walk without caliper or stick.
Material & Methods: In the last 10 Years, 122cases,of post-polio deformity of lower limb , were corrected with Ilizarov and without Ilizarov. All the patients were evaluated for muscle charting, gait studies and measurement of deformities at hip, knee joints. The discrepancies of lengths were also noted in the thigh or leg levels.
Treatments involved Closed Supracondylar Osteotomy with Plaster (n=15),Closed Supracondylar Osteotomy with Inter-trochanteric Osteotomy followed by Tibial traction (n=9),Supracondylar Osteotomy with correction with Ilizarov ,with lengthening at osteotomy (n=10),without lengthening at osteotomy (n=35).
Supracondylar Osteotomy with Inter-trochanteric Osteotomy with Ilizarov,with lengthening at osteotomy (n=7),without lengthening at osteotomy (n=42-),Inter-trochanteric Osteotomy with Ilizarov with lengthening (n=4).
X- rays were done to see the radiological status of unions, correction of angulation, bone formation in lengthening. The patients were made to walk with Ilizarov apparatus and gaits were analyzed .Fine corrections (Valgus/ varus,sagittal plane)were done.
The osteotomies were dynamised and later on the apparatus was removed. The limbs were protected with splints post operatively along with vigorous physiotherapy. Their hands (while walking) on the thighs were removed, gait of patients improved. The girth of the limb also improved. Most of patients did not need caliper or stick.
Results: These are difficult procedures for the patients and the doctors. There is no literature available because the West has started deleting the subject in the books. There is hardly any paper read in the conferences/ written in the books/ journals.In certain cases the cause of hand thigh gait is flexion deformity at hip with or without the knee deformity. Until and unless this is also corrected, hand thigh gait will remain.Lengthening in these cases are difficult and time consuming. Complication like pin track infection ,delayed healing of the osteotomies, collapse of lengthening site , knee joint stiffness, did took place.
Conclusion: Bony operation preserve the muscles of poliotic limb and change the effect of ground reaction to the gait. Ground reaction vector instead of passing behind the knee joints, passes infront of the knee joint obviating the need to use hands on thighs.
How to Cite this Abstract
Swagatesh Bastia. Grade III(A and B) Compound Tibial Diaphyseal Fractures Treated with Primary Wound Debridement and Intramedullary Interlocking Nailing. April 2014;1(1): 17.