The patient underwent an open reduction of her dislocated ankle joint, an excisional debridement, and irrigation of open fractures in her ankle joint ligaments. She was given a two-week course of antibiotics and her cultures showed no growth. The patient subsequently developed vestibulopathy leading the patient to be left on disability. It was alleged that the patient developed vestibulopathy secondary to antibiotic toxicity. It was further alleged that changes were made to the pre- and post-op antibiotic protocol dictating that the antibiotics in question should not be prescribed for extended periods. An expert orthopedic surgeon was sought to review the medical records and discuss whether or not the standard of care was followed in this case.
Question(s) For Expert Witness
Do you routinely treat and evaluate patients similar to the one described?
Do you currently prescribe antibiotics for orthopedic trauma?
How long do most patients require antibiotics after orthopedic trauma?
Expert Witness Response E-053604
I have experience treating both open and closed fractures. I currently serve as the assistant residency director of orthopedic surgery at a major university hospital, and I teach courses for resident education in the area. The timing of antibiotics after open fractures is dependent on the severity of the open fracture. The more severe the soft tissue injury the longer the antibiotics tend to be used. There is no official standard as to duration. Generally, the antibiotics will be given pre-op and then for 24-72 hours post-op depending on fracture and soft tissue severity and findings at the time of debridement. There is always a trade-off with severe open fractures and the need for antibiotics. If the risk of infection and potential amputation is felt to be greater than the risk of ototoxicity from antibiotics, then it may be prudent to use this antibiotic.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
