Orthopedic surgery in polyhandicapped adults with low mental level

Purpose of the study The object of this study was to define the requirements for successful mana gement of polyhandicapped adults with low mental level. The goal of surgery was to improve motion performances, suppress pain, improve sitting positio n, and facilitate handicapped adults life. Material Thirty-five adults operated during a period of 20 years with a follow-up be tween 6 months and 20 years were studied. Three of them died within 2 month s postoperatively due to causes unrelated to surgery. Method Surgical procedures performed were adductor tenotomies, femoral or pelvic o steotomies, femoral resections, triple arthrodeses of the foot, spine arthr odesis, lengthening of Achilles tendon, and 2 cases of femoral fractures. Results The functional goal was achieved in all cases. In 3 cases, we observed post operative psychic regression. Discussion The surgeon must make every effort to achieve successful outcome in such ca ses without creating or exacerbating a behavioral impairment. Team discussi ons, choice of operative procedures, quality of resuscitation, and rapid re turn to usual life were the main factors required for successful outcome. Conclusion Functionnal results obtained regularly in this series justifies using surge ry in such cases. Cost is lower, patient's quality of life is improved, the handicapped adults relationships with others are better, and caretaker's t asks are facilitated.