Dr. J S R G Saran, Department of Orthopaedics, M S Ramaiah University of Applied Sciences, MSR Nagar, Bengaluru - 560094, Karnataka, India. E-mail: jsaran868@gmail.com
Background: Femoral shaft fractures in limbs affected by post-polio residual paralysis (PPRP) are prone to non-union and implant failure due to altered biomechanics, deformities and compromised bone quality.
Case Report: A 36-year-old male with PPRP presented with painful inability to bear weight following implant failure of a previously nailed femoral fracture. Radiographs showed hypertrophic non-union with a bent retrograde nail and screw back-out. Exchange nailing was performed using modified positioning to accommodate severe PPRP-related deformities.
Results: The distorted nail was successfully removed, deformity corrected gently, and a larger, longer nail implanted. At 1-year follow-up, radiographs confirmed complete union. The patient achieved pain-free full weight-bearing and functional knee motion with tailored rehabilitation.
Conclusion: Exchange nailing is an effective solution for hypertrophic non-union with implant failure, even in complex PPRP-affected limbs, when individualized surgical planning and rehabilitation are employed.
Keywords: Post-polio residual paralysis, Femoral non-union, Bent intra-medullary nail, Implant failure, Exchange nailing, Deformity correction.
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