Complications in the surgical management of femur fractures in children with non-ambulatory cerebral palsy

Abstract

Presentation ZS is a 16-year-old female with mixed CP, gross motor function classification system (GMFCS) level V and uncontrolled epilepsy. Her parents gave a history of bilateral clavicle fractures and a left femur fracture which was treated surgically with an open reduction and plate fixation in 2012. The current episode occurred after she fitted and fell from her bed. Although verbal communication was impossible it was clear that she was suffering from severe pain in the right thigh. Examination revealed a patient with severe total body CP, poor nutritional status, multiple contractures involving the hip, knee and ankle with an extremely tender right groin and proximal thigh. Plain X-rays of the pelvis and femurs showed the healed left midshaft femur fracture and the new right completely displaced sub-trochanteric femur fracture as shown in Figures 1 and 2. The patient was treated surgically, with an open reduction and internal fixation using a blade plate for the right sub-trochanteric femur fracture and removal of the locked plate at the same surgical sitting. The bone was extremely osteoporotic. She fitted again day 0 post-operatively, causing a re-fracture of her right femur resulting in the blade plate pulling out of her femoral neck (Figure 3). The left femur remained intact after removal of the locked plate at the same surgical sitting.