Neglected Surgical Site Infection Leads to Patient Death

Case Overview

This case summary involves a patient with a medical history of diabetes and peripheral vascular disease (PVD). They sustained a severe right ankle fracture, specifically identified as a comminuted, displaced, right-side bimalleolar ankle fracture. Following the injury, they underwent Open Reduction Internal Fixation (ORIF) surgery on their right ankle. However, due to complications involving failed hardware and syndesmosis instability, they required revision surgery shortly after.

Postoperatively, signs of wound infection emerged, including fluid drainage with pus and skin separation at the incision site. Despite these clear indications of infection, no additional diagnostic workup was performed to assess the situation. Two months post-surgery, the surgeon noted that the wound was not healing properly and surgical hardware was exposed. Wound cultures were taken which confirmed an infection. The patient subsequently underwent multiple surgeries to treat the infection and osteomyelitis, including hardware removal.

Unfortunately, the patient remained bedridden and died later that year. This case requires an expert opinion from an infectious disease specialist to review the medical records. This will provide insights into the standard of care provided and the cause.

Questions to the Infectious Disease and Communicable Disease expert and their responses

How often do you evaluate and manage surgical site infection patients, including orthopedic surgical patients?

As a clinically active infectious disease physician, I evaluate and manage patients diagnosed with surgical site infections almost daily. This includes orthopedic surgical patients whom I follow both as in-patients and out-patients.

What are the most pertinent measures providers can take to minimize surgical site infections?

To minimize surgical site infections, providers should perform several measures such as assessing the wound regularly, sending Erythrocyte Sedimentation Rate (ESR)/C-Reactive Protein (CRP) as lab markers of infection, and obtaining a wound culture if purulent drainage is observed.

Have you reviewed a case similar to above?

I have reviewed many orthopedic cases involving joint and spine infections. However, I do not recall reviewing a case involving an ORIF infection specifically. I am confident in my ability to provide valuable insights based on my extensive experience with orthopedic infections.

About the expert

This expert is a seasoned infectious disease specialist with nearly two decades of experience in the field. They are board-certified and have held numerous prestigious roles, including serving as the medical director of infectious diseases at multiple hospitals and the program director of an infectious diseases fellowship at a renowned university. Currently, they hold a professorship in medicine and serve as the chief of infectious diseases at a medical school, while also acting as the medical director for infection control and prevention and antimicrobial stewardship for several hospitals.

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Specialties:

Infectious Disease and Communicable Disease

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.