Orthopedic Surgeon Fails To Remove Bone Fragment During Ankle Surgery

This case involves an elderly male patient who required surgery to repair an ankle fracture he sustained while skiing. The patient had seen an orthopedic surgeon in the past but elected to see a different surgeon for this procedure because of a negative experience with his previous physician. The new surgeon performed the operation without taking new x-rays and relying on imaging studies from previous doctors. Within several weeks of the surgery, the patient began to feel pain and discomfort in his ankle. He consulted the surgeon, who claimed that the pain was a typical side effect of the procedure and that there was no cause for alarm. After 6 months of pain, the patient consulted yet another orthopedic surgeon, who took new x-rays of the patient’s ankle. It was finally discovered that a bone fragment was not removed during the initial operation. The fragment had caused severe damage to the patient’s tendon and he required additional operations to repair the damage.

Question(s) For Expert Witness

1. Have you ever had a patient develop the outcome described in the case? If so, please explain.

2. Do you believe this patient may have had a better outcome if the care rendered had been different?

Expert Witness Response E-010208

I am director of the foot and ankle center of a major university-affiliated medical center. I operatively treat close to 1 ankle fracture per week. Although I have seen various situations and scenarios, I have never had a patient develop this outcome. I think that it's important to know the location of the bony fragment and which tendon was injured by looking at the radiographs. Based on the story, it seems that the patient would have done better if the fragment had been removed, but it is important to know if that fragment was visible with good imaging studies.