Combined tibial lengthening and ankle arthrodesis for patients with certain type of sequelae of poliomyelitis

Abstract

Purpose: Following far advancement of modern medicine and technology, functional disability in a certain type of sequelae of poliomyelitis may be effectively improved. Methods: Eight consecutive adult patients with unilateral sequelae of poliomyelitis were treated. These patients had shortened lower extremity of an average of 4.8 cm (range, 4.0-5.5 cm) in the lesion side. Muscle power of the ipsilateral knee was nearly intact (grade 4 or 5) but the ankle extension was completely flaccid. The tibia was osteotomized and lengthened with external fixation. Consequently, all external fixators were converted to plates supplemented with autogenous corticocancellous bone graft and bone graft substitute. Ankle arthrodesis was performed concomitantly. Results: Seven patients were followed up for an average of 3.7 years (range, 2.2-5.4 years). All seven lengthened sites healed with an average union time of 3.9 months (range, 3.5-4.5 months) after plating. One ankle infection occurred. Gait function significantly improved by modified Mazur scoring evaluation (p = 0.02). At the latest follow-up, all patients had a minimal or unnoticed limp in level walking. Conclusion: The described combined techniques may be an excellent alternate for treating selected patients with sequelae of poliomyelitis. The procedure is not complex but the efficiency is extremely prominent.