Anorexia and supracondylar fracture of the femur following surgery for bilateral lower limb joint contracture in a case of severe cerebral palsy with mental retardation: a case report

Abstract

Objective: Postoperative management of children having cerebral palsy (CP) with mental retardation is difficult. This report presents a case of severe CP with mental retardation, which resulted in anorexia and condylar fracture of the femur following a surgery for bilateral lower limb joint contracture. Case report: A 14-year-old male was diagnosed with CP having severity of Gross Motor Functional Classification System Level V, and severe mental retardation. Due to bilateral spasticity in hip adduction, knee flexion, and valgus of the feet, tenotomies of the adductors of both hips, bilateral lengthening of the hamstrings and bilateral tenotomy of the peroneal tendons were performed. At 4 weeks postoperatively, knee casts were used; thereafter, knee extension braces were attached for 12 weeks. After surgery, he showed severe anorexia for 8 weeks and weight loss of 8.8 kg (from 35.2 kg to 26.4 kg) during the 4 months of hospitalization. Six months postoperatively, he was diagnosed with supracondylar fracture of the right femur. Discussion: Severe CP with mental retardation requires attention to the physical symptoms caused by stress related to the hospitalization, surgery, fixation by casts, and braces. Moreover, care must be taken not to increase the risk of fracture by fixation or immobility of the postoperative cast, because it can lead to the progression of low bone mineral density.

Keywords: anorexia; cerebral palsy; contracture; fracture; mental retardation.

Figure 1

Progression of the patient’s condition.

Figure 2

X-ray images with antero-posterior and lateral views showing the right femoral supracondylar fracture. (a) At the time of fracture (2 months after discharge (6 months after surgery)). (b) At the time of fracture fusion.