RESUMEN
PURPOSE OF THE STUDY: The object of this study was to define the requirements for successful management of polyhandicapped adults with low mental level. The goal of surgery was to improve motion performances, suppress pain, improve sitting position, and facilitate handicapped adults life. MATERIAL: Thirty-five adults operated during a period of 20 years with a follow-up between 6 months and 20 years were studied. Three of them died within 2 months postoperatively due to causes unrelated to surgery. METHOD: Surgical procedures performed were adductor tenotomies, femoral or pelvic osteotomies, femoral resections, triple arthrodeses of the foot, spine arthrodesis, lengthening of Achilles tendon, and 2 cases of femoral fractures. RESULTS: The functional goal was achieved in all cases. In 3 cases, we observed postoperative psychic regression. DISCUSSION: The surgeon must make every effort to achieve successful outcome in such cases without creating or exacerbating a behavioral impairment. Team discussions, choice of operative procedures, quality of resuscitation, and rapid return to usual life were the main factors required for successful outcome. CONCLUSION: Functional results obtained regularly in this series justifies using surgery in such cases. Cost is lower, patient's quality of life is improved, the handicapped adults relationships with others are better, and caretaker's tasks are facilitated.