Olympic Athlete Is Unable To Compete Following Incomplete Ankle Surgery

This case involves a 3-time Olympic athlete who suffered a trimalleolar fracture to her right foot in the course of a game. An MRI of the ankle revealed a fracture of the lower fibula with a malleolar avulsion fracture. A CT scan also noted irregularity of the talus. The defendant physician performed an open reduction and internal fixation of the right ankle but did not address the talus irregularity during the surgery or follow-up visits. Within two months, the physician advised the patient that she could begin training again without any limitations. After having received the optimistic prognosis, the patient engaged in an aggressive rehabilitation. Within a month, she was unable to walk. She visited another orthopedic surgeon for a second opinion. An x-ray of the right ankle revealed that the talus deformity had worsened due to the ankle cartilage rubbing against the defect. The second physician surgically addressed the talus lesion but found bony fragments in the ankle joint and multiple areas of degenerative cartilage. After the surgery, the patient was evaluated for by an Olympic team physician. This physician reported that the patient’s talus lesion was very concerning and was pessimistic about the patient’s chances of being able to compete. As a consequence of this report, the team elected not to reinvite the athlete to the Olympic team. An expert in orthopedic surgery with expertise in sports medicine was sought to review the medical documentation and determine whether the severe state of the patient’s condition could have been prevented during the course of her treatment.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in the case? Please explain.

2. Do you have experience treating athletes?

3. Have you ever had a patient develop the outcome described in the case?

Expert Witness Response E-010208

I routinely treat patients with osteochondral lesions and Weber C ankle fractures and I'm quite familiar with the association of this type of ankle fracture and osteochondral lesions. I treat patients with both of these conditions and have never had a patient develop this type of outcome. I am very familiar with the literature regarding treatment and outcomes for athletes with osteochondral injuries and have experience treating college athletes.