Case Archive
Orthopedic Surgery
Ref. # 02218

A 47 year old Pennsylvania woman with a prior severe right ankle sprain sought treatment for right heel pain. Treatment consisted of cortisone shots and orthotics for possible right plantar fascitis. One month later the patient complained of continued pain. She underwent a partial fasciotomy with planned decompression of the lateral plantar nerve. Intra-op the plantar medial nerve was found to be degenerative and was removed. Post-op treatment included physical therapy and Daypro. During periodic follow-up exams, the patient complained of pain, and was advised to undergo a second surgery including fusion. She consulted another physician, who diagnosed a neuroma. Corrective surgery included repair of the plantar fascia. A medQuest orthopedic surgeon reported that less than 5% of patients with proximal plantar fascitis require surgery. Standard of care requires non-operative therapy including non-steroidal anti-inflammatories, corticosteroidal injections, heel cushions/casting, and physical therapy for at least six months. Additionally, the neurectomy was inappropriate and led to the patient's right heel pain and numbness. The subsequent complications and surgery were avoidable.

Orthopedic Surgery
Ref. # 11628

A 60 year old New York woman at high risk for pulmonary emboli underwent a total knee replacement. Post-op the patient's protime/prothrombin times (chemical substances important in blood coagulation) were never in the appropriate ranges. The patient died two weeks later from massive pulmonary embolism. A medQuest orthopedic surgeon reported there was a failure to adjust the Coumadin dosage according to the PT/PTT ranges. With proper prophylactic treatment the woman would have survived.

Orthopedic Surgery
Ref. # 80738

A 55 year old Florida man presented to his physician with symptoms of impotence and left leg numbness. An MRI revealed an L4-5 disc bulge and an L5-S1 herniation. The patient underwent a lumbar laminectomy and disectomy at L4-5, with fusion. Five months later the patient returned with symptoms of RSD. The attending orthopedist's notes indicated he had missed the L5-S1 disc space during the surgery; the patient required a decompressive laminectomy at L4-S1 with instrumentation. A medQuest orthopedic surgeon specializing in spine surgery reported that the initial surgery was negligently performed at the wrong level. Had it been performed correctly, the patient could have avoided the development of RSD.

Orthopedic Surgery
Ref. #34358

An Ohio woman suffered a severely comminuted displaced fracture of the left radius. An orthopedic surgeon performed a closed reduction and placed a short arm cast. The woman developed malunion, requiring two surgical procedures thereafter. The attorney questioned whether an initial open reduction would have precluded the subsequent procedures. A medQuest orthopedic surgeon found the best initial procedure would have been an external fixation or pinning. It was below the standard of care to place a short arm cast, unless the patient refused surgery and casting was the only available option.

Orthopedic Surgery
Ref. # 10358

A 35 year old Utah man underwent arthroscopic knee surgery. Two weeks later the knee and lower leg were swollen, with severe pain for which the prescribed medication was ineffective. The treating orthopedic surgeon was unavailable; a second removed the ace bandage and prescribed a different pain medication. The pain continued and the patient saw the first orthopedic surgeon, who probed and drained blood from the site. Two days later the patient's temperature rose to 104 and an oral antibiotic was prescribed. Two days later the patient underwent another probe, results of which were gram positive but apparently undocumented. A second arthroscopic surgery was performed, during which drains and an evacuation pump were inserted. Follow-up care included IV antibiotics, pump care and monitoring three times daily by nurses. This lasted two days, after which the drains were removed and the IV antibiotics were cancelled. During the next month, the patient underwent physical therapy, which became increasingly difficult. He continued to complain of severe knee pain and swelling and he lost 50 pounds. Two weeks later, after consulting a psychiatrist and a physiatrist, the patient phoned the orthopedic surgeon, who was unavailable; the second said that swelling of the knee was not cause for hospitalization. The patient was referred by the physiatrist to another care unit, where blood clotting was found and a staph infection was diagnosed. The initial orthopedic surgeon removed and scraped the infected bone tissue and flushed the site. The patient was discharged then readmitted the same day due to light-headedness and immobility. Ten days later the patient was discharged. Under different doctors, he continued with oral antibiotics and physical therapy and ultimately required another surgery to clean out infected tissue. A medQuest orthopedic surgeon reported that after the first surgery there were three days of negligent antibiotic management, during which there was no attempt to monitor the patient's condition through aspiration, repeat cultures or sedimentation rates. The patient's weight loss and chronic pain and stiffness, signs of an infection, were ignored. The patient's subsequent surgeries and pain and suffering were avoidable.

Orthopedic Surgery
Ref. # 54108

A 63 year old Minnesota man complained of back pain for 12 weeks, during which an MRI showed a disc herniation causing L4 nerve root impingement inferior to the L4 pedicle. The patient underwent a lumbar decompressive procedure. Intra-op his blood pressure dropped suddenly. Low presser medications were ineffective. It was determined the patient had a very low hemoglobin. Three hours after the complication arose, an exploratory laparotomy was performed to control the bleeding. A lacerated anterior iliac artery was identified. Numerous attempts to control the bleeding over the next 7-8 hours were ultimately unsuccessful and the patient expired. A medQuest orthopedic surgeon specializing in spine surgery opined that it was negligent to violate the anterior space of the disc, which caused the vascular injury and was responsible for the patient's death. Furthermore, there was a negligent delay in diagnosing the injury and ordering extensive fluid replacement as well as blood products, and securing a consultation from a vascular or general surgeon. The patient's death was avoidable.

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