Orthopedic Surgeon Fails to Secure Surgical Plates During Ankle Fracture Repair

This case involves a forty-seven-year-old female patient who sustained a severe compound fracture of the ankle joint. The operating physician performed an ORIF (open reduction internal fixation), with the placement of a surgical plate but the decision for surgical screw placement in the fixation procedure was decided against. As a result, the patient developed a migrating fracture down the length of the tibia which was attributed to a displaced surgical fixation plate. The plates were eventually removed but the patient now experiences an altered gait when walking and extreme chronic pain.

Question(s) For Expert Witness

1. What was the surgeon's reason for deciding not to place screws in the fixation of the ankle joint and could this complication have been avoided?

Expert Witness Response

Malunion of the fracture site occurs more frequently than nonunion and potentially proceeds to degenerative changes of the joint which seems to be what occurred in this case. As a result of amalunion fracture, chronic symptoms such as pain, weakness, and instability of the ankle may develop. Compared with closed ankle fractures, open ankle fractures must have an orthopedic surgeon on the case as open fractures are surgically repaired. Every surgical situation is different based upon the facts of the case. In conclusion, the treatment of malleolar fractures and the management of these fractures involves a thorough examination from the orthopedic surgeon to avoid these types of complications.