Recurrent fixation failure of a distal femur fracture associated with intellectual disability: A case report.

INTRODUCTION AND

IMPORTANCE

Distal femur fractures, particularly in patients with intellectual disabilities, pose unique challenges due to factors such as non-compliance with postoperative instructions and recurrent fixation failures. These complications necessitate multiple surgical interventions, increasing morbidity and disability.

CASE PRESENTATION: A 59-year-old female with intellectual disability and comorbid diabetes and hypertension sustained a distal femur fracture. Initial management included open reduction and internal fixation (ORIF) with plating. However, due to non-adherence to postoperative instructions, the patient experienced recurrent fixation failures, necessitating two revision surgeries involving long lateral distal femur locking plates and additional stabilization techniques, including cerclage wiring. Despite comprehensive care, the patient faced prolonged recovery and functional limitations.

CLINICAL DISCUSSION: We present the challenges in managing distal femur fractures in patients with cognitive impairments, including non-compliance and biomechanical complications. Also, we highlight the importance of advanced surgical techniques, tailored postoperative care, and close monitoring to prevent recurrent failures. A holistic care approach addressing both physical and cognitive aspects is essential for improving outcomes in this vulnerable population.

CONCLUSION

Managing distal femur fractures in intellectually disabled patients requires a combination of advanced fixation techniques, enhanced patient and family education, and vigilant follow-up to mitigate complications. This case emphasizes the need for multidisciplinary strategies that integrate psychological resilience into perioperative care to optimize recovery and reduce long-term disability.