Delayed Diagnosis of Septic Joint After Ankle Surgery

Case Overview

This case involves an eighteen-year-old female patient who underwent a Brostrom-Gould ankle reconstruction procedure. It was conducted without incident aside from minor swelling of the limb. The patient was discharged and returned five days after surgery for a follow-up appointment to remove a temporary cast. The patient was sent home with a splint around the surgical wound and told to return in ten days for further evaluation. The following day, the patient was taken to the ER for extreme pain that was not alleviated by a Percocet prescription. After several hours, she was admitted for a high temperature, increasing blood pressure, and an elevated WBC count on laboratory reports. A consultation with the orthopedic team revealed that she was suffering from a septic joint that required surgical debridement and a washout procedure.

Questions to the Orthopedic Surgery expert and their responses

What was the first line treatment that should have been given to this patient to prevent the infection?

Combined therapy with oxacillin and gentamicin was effective against 88.1% of the infecting microorganisms.

About the expert

This expert has been practicing for approximately 30 years, and is fellowship trained in pediatric orthopedic surgery. Throughout his medical career, he has been appointed to such high ranking medical positions as chief of surgery at an area healthcare center. His current practice includes general adult and pediatric orthopedic surgery, and he is affiliated faculty at thee regional hospitals.