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

## TL;DR

A patient with intellectual disability and a distal femur fracture faced repeated surgical failures, highlighting the need for tailored care and advanced techniques in such cases.

## Contribution

This case report highlights the challenges and solutions in managing distal femur fractures in patients with intellectual disabilities.

## Key findings

- Recurrent fixation failures occurred due to non-compliance with postoperative care.
- Advanced surgical techniques and holistic care improved outcomes.
- Multidisciplinary strategies are essential for vulnerable populations.

## Abstract

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.

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.

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.

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.

•Challenges of managing distal femur fractures in patients with intellectual disabilities•Recurrent fixation failures necessitated advanced surgical interventions.•Holistic care approach integrating cognitive and physical aspects improved outcomes.•Psychological resilience and patient education critical in perioperative care•The case emphasizes tailored strategies to prevent complications in vulnerable populations.

Challenges of managing distal femur fractures in patients with intellectual disabilities

Recurrent fixation failures necessitated advanced surgical interventions.

Holistic care approach integrating cognitive and physical aspects improved outcomes.

Psychological resilience and patient education critical in perioperative care

The case emphasizes tailored strategies to prevent complications in vulnerable populations.