POST POLIO RESIDUAL PARALYSIS (PPRP)

Introduction

Poliomyelitis is an acute viral infection caused by polio virus which attacks the anterior horn cells of the spinal cord. The patients coming to orthopaedic surgeons are actually showing the post polio residual paralysis(PPRP). The damaged anterior horn cells can never be recovered. During the acute phase, when the child is treated by the paediatric physician, care must be taken to splint the limbs in functional positions, so that the deformity formed is minimum.

The neurones affected are mostly of the lower limb and usually one limb is involved more than both the limbs. Upper limb involvement is uncommon.

For this condition, muscle power cannot be improved, but only deformities can be corrected. Muscle transfers only can improve the power in some muscle groups(Paralysed once).

Clinical Features

·       It is a flaccid type of paralysis, where the muscle tone is decreased.

·       Muscle power is decreased, may be from 0 to 4.

·       Most common muscle group involved is Quadriceps Femoris and Teridoachillis, though other groups may also be involved.

·       Patient has short limb with muscle wasting.

·       Deformities at hip, knee and ankle can be seen, depending upon the severity of involvement.

·       Mostly hand on knee gait is seen.

·       Secondary changes may be seen in Hip and Spine.

·       History is since child hood and not since birth.

Investigations

·       Clinical examination and history is of prime importance.

·       X-Rays of the deformed areas must be taken to assess the degree of severity which needs to be corrected.

·       X-rays will show underdeveloped bones, in addition to various deformities at the joints.

Treatment:

·       In the initial phases of acute infection, care must be taken to splint the joints in functional positions so as to avoid the severe contracture formations.

·       In late stages, splintage and sometimes traction to rectify the deformities can be of some help.

·       Mostly these people need various surgical procedures, depending upon the deformities present, to rectify the deformities or tendon transfer surgeries to improve the muscle power in a particular group of muscles or the limb lengthening procedures to equal both the limbs.

·       Surgery may be needed at Hip, Knee or ankle alone or at a combination of these joints.