Lower Limb Fractures in Patients with Post-polio Residual Paralysis: A Systematic Review and Pooled Analysis of Patterns, Mechanisms, and Outcomes.

BACKGROUND: Poliomyelitis can cause long-term neuromuscular deficits, predisposing survivors to lower limb fractures. Altered biomechanics, muscle weakness, and osteopenia complicate management, yet comprehensive evidence on fracture patterns, treatment, and outcomes is limited. OBJECTIVES: To systematically review lower limb fractures in patients with post-polio residual paralysis (PPRP), analyzing epidemiology, mechanisms of injury, management strategies, complications, and functional outcomes. METHODS: A systematic search of PubMed, Embase, and Scopus (PROSPERO: CRD420251180231) identified cohort studies, case series, and case reports reporting lower limb fractures in PPRP patients. Data on demographics, fracture characteristics, management, complications, and functional recovery were extracted. Pooled analyses were performed for low-energy falls and nonunion rates using a random-effects model. Study quality was assessed with the Newcastle-Ottawa Scale and Joanna Briggs Institute checklist. RESULTS: Twenty-two studies reporting 443 lower limb fractures were included. Femoral fractures, particularly femoral neck fractures, predominated (33%). Low-energy falls accounted for 79% of injuries (95% CI 0.70-0.87). Operative management was performed in 72.5% of the lower limb fractures, and conservative management was used in 27.25%. Nonunion occurred in 8% of these fractures (95% CI 0.03-0.14), postoperative infection in 12% (95% CI 0-0.39), and revision surgery was required in 17% (95% CI 0.08-0.29). Modified surgical techniques generally achieved stable union, and structured rehabilitation with orthotic support facilitated functional recovery. Management was often challenged by deformities, osteopaenia, and altered anatomy. CONCLUSIONS: Lower limb fractures in PPRP predominantly involve the femur and result from low-energy falls. Operative management is common. Despite heterogeneity and study limitations, these findings provide clinically useful guidance and highlight the need for further research.PROSPERO ID: CRD420251180231.