Wound Infection Leads to Amputation

Case Summary

This case involves a patient who had sustained an open fracture of the heel bone during a fall from a significant height. The open fracture was diagnosed in the ER, where a cast was placed and the patient was discharged the next day without surgery. The patient’s wound infection spread eventually leading to the amputation of his leg.

Questions

Was the patient properly cared for by the attending Emergency Medicine physician? Are there any other treating physicians who were negligent in terms of the care provided? If there was any deviation from the standard of care, did the delay in treatment cause the patient’s damages i.e. need for his leg to be amputated?

Experts’ Findings

AMFS’ experts (Emergency Medicine and Hospitalist) reviewed this case matter and provided the following opinions:  Open calcaneus fractures require emergent surgical intervention – not on an elective outpatient basis. The choice of antibiotics administered was also suspect; broad-spectrum IV antibiotics are indicated for open fractures, but none were utilized in this case. The initial orthopedic consultation indicates that they did not feel the wound communicated with the fracture.  Physicians are taught that any wound within a reasonable proximity to a fracture should be considered an open fracture, especially with such a severe mechanism. By referring to orthopedics, the ER physician acted appropriately and the initial responsibility in this case belongs to the attending orthopedist during the inpatient visit.  The follow-up orthopedist also never seemed to see the wound as much of a problem as it was not fully explored and debrided until about a month after the injury.  His notes continue to say there is no evidence of deep infection up until the note in which he recommends amputation.  The orthopedists were found to be negligent in their care of this patient and it resulted in his need for limb amputation and his permanent disability.