Excessive Nerve Damage After Ankle Reconstruction Procedure

Radiology reports showed an oblique fracture of the distal fibula near the lateral malleolus, a fracture of the posterior malleolus, cortical avulsion fracture from the inner-side of the median malleolar base, and lateral subluxation of the talus with the widening of the medial ankle joint space. The patient had surgery to repair her ankle, which resulted in numerous complications, including malunion of the joint. The procedure performed was an open reduction and internal fixation. Postoperatively, the patient complained of a burning and tingling sensation in her ankle and toes. It was later determined that significant sural and superficial peroneal nerve damage had occurred. Despite continued care and rehabilitation, the patient continued to experience pain and disability.

Question(s) For Expert Witness

1. Was the proper follow-up and rehabilitation rendered to this patient?

Expert Witness Response E-000183

The first phase of rehabilitation is restoration of motion and pain-free ambulation after cast immobilization. During the first several days after cast removal, crutch-assisted ambulation can assist the patient in gaining motion and in preventing ankle reinjury secondary to weakness. After the return of passive motion, active motion and active-assisted motion should begin, along with a strengthening program. Particular attention is devoted to the recovery of peroneal and gastrocnemius complex strength. Proprioception and balance training are also an important part of the overall rehabilitation program and have been shown to be effective in reducing the risk for recurrent ankle injury. Nonunion or delayed union is the most common complication of ankle fractures requiring further surgical intervention.