Delayed Infection Diagnosis After ORIF Leads to Death

Case Overview

This case involves an individual with a history of diabetes and peripheral vascular disease who suffered a right ankle fracture. Following the injury, the patient was admitted to the hospital and diagnosed with a comminuted, displaced bimalleolar ankle fracture. Surgical intervention was initiated promptly, with an open reduction and internal fixation (ORIF) performed the day after the injury. However, complications arose when the patient required revision surgery shortly thereafter due to failed hardware and instability in the syndesmosis of the ankle.

Postoperatively, the patient exhibited signs of wound infection, characterized by fluid drainage with pus and skin separation at the incision site. Alarmingly, no additional diagnostic workup was conducted to evaluate the potential infection. Approximately two months later, the surgeon noted non-healing of the wound and exposed surgical hardware. Subsequent wound cultures confirmed the presence of an infection, leading to multiple further surgeries to manage the infection and osteomyelitis. Tragically, the patient ultimately became bedridden and passed away in the following years.

In light of these events, an expert in infectious disease has been engaged to review the medical records and provide insights on the standard of care and potential causation for the complications that followed the initial surgical procedure.

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

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

I am a clinically active infectious disease physician that sees orthopedic infections nearly every day and follows them both in-patient and out-patient.

What are the most pertinent measures that providers can perform to minimize the incidence of surgical site infection?

To minimize the incidence of surgical site infection, providers should assess the wound, send ESR/CRP as lab markers of infection, and obtain wound culture if purulent drainage.

Have you reviewed a case similar to the one described above? If so, please briefly describe.

I have reviewed many orthopedic cases regarding joint infections and spine infections; however, I do not recall an ORIF infection. I would be happy to discuss further and lend my expertise.

About the expert

This expert has nearly 20 years of experience in the field of infectious disease medicine. He earned his BA in biology from Cedarville College, followed by his MD from Wright State University, remaining there for his internship and residency in internal medicine and fellowship in infectious diseases. Today, this expert is board-certified in infectious disease and is a member of multiple professional societies, has been published extensively with numerous presentations given across the country and internationally, and is active in research with several grants and pharmaceutical studies. He is a peer reviewer and editor for many different journals and has been involved with establishing national guidelines on different topics in his field. He has served as a physician for three different hospitals in Ohio and was the medical director of infectious disease as well as the section chief of internal medicine at Greene Memorial Hospital. This expert later served as the infectious diseases advisor for the Miami Valley Hospital transplant program and as the medical director of infectious diseases and employee health at Indu and Raj Soin Medical Center and Kettering Health Network, respectively. He was the program director of the infectious diseases fellowship at Wright State University for over a decade. Currently, he serves as a professor of medicine and the chief of infectious diseases at a medical school in Ohio. In addition, he serves as the medical director for infection control and prevention and antimicrobial stewardship for multiple hospitals as well as for a tuberculosis clinic for a health district, all based in Ohio.

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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.