Rehabilitation of a Case of Post-Operative Paraplegia in Arthrogryposis Congenita Complex

Abstract

Arthrogryposis is an orthopedic condition characterized by greater or lesser stiffness at the four members and less frequently of the spine. Treatment is with certain orthopedic surgical indications in functional aim. The purpose of this work is to present a complex case of arthrogryposis multiplex congenita with partially reversible neurological complications following spinal surgery.Presentation of the case of a ten year old boy, who had previous surgeries in the lower limbs, addressed in the department of Physical and Rehabilitation Medicine of the National Orthopaedic Institute Mohamed Taieb Kassab, twenty one days after a kyphosis and lumbar dorsal scoliosis surgery complicated by paraplegia justifying the removal of material. The clinical examination at the admission found a paraplegia ASIA C D4 with neurogenic bladder. The multidisciplinary care was provided in the department of Physical and Rehabilitation Medicine in two hospitalizations with progressive goals (analgesia, joint gain, standing up, walk, urinary autonomy and rehabilitation).Six months after the second hospitalization, the child had regained the standing position, walking with adapted equipment, and bladder balance.Arthrogryposis manifests by stiff joints, interesting the four members, with skin abnormalities and occurs in children with normal intelligence. Treatment is based on assiduous care with physiotherapy care, occupational therapy and early orthopedic continued throughout growth. Surgical treatments deformations there are delicate, with poorer results than in idiopathic etiology.The management in physical medicine were based on multidisciplinary cares, enabling the patient to walk, to have a better autonomy and urinary balance, allowing to hope for a good family and social insertion, particularly the resumption of his schooling.