Delayed Diagnosis of Septic Joint After Ankle Surgery

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.

Question(s) For Expert Witness

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

Expert Witness Response E-000379

Septic arthritis of the ankle joint is a rare but serious disease. Very few reports in medical literature in the past have mentioned the method of care and treatment results of septic ankle. In recent studies, Staphylococcus aureus was the most common infecting microorganism in septic ankles. Combined therapy with oxacillin and gentamicin was effective against 88.1% of the infecting microorganisms. The poor prognostic factors for septic ankle include a positive bacterial culture, involvement of multiple joints simultaneously, a delay in treatment, and an increased number of associated diseases. Early treatment (symptom duration of less than five days) significantly affected the final results. The early recognition and prompt treatment of this condition may reduce morbidity and mortality.