Orthopedic Surgery Patient Allegedly Develops Complications From Antibiotic Toxicity

Case Overview

The patient underwent an open reduction of her dislocated ankle joint, an excisional debridement, and irrigation of open fractures in her ankle joint ligaments. She was given a two-week course of antibiotics and her cultures showed no growth. The patient subsequently developed vestibulopathy leading the patient to be left on disability. It was alleged that the patient developed vestibulopathy secondary to antibiotic toxicity. It was further alleged that changes were made to the pre- and post-op antibiotic protocol dictating that the antibiotics in question should not be prescribed for extended periods. An expert orthopedic surgeon was sought to review the medical records and discuss whether or not the standard of care was followed in this case.

Questions to the Orthopedic Surgery expert and their responses

Do you routinely treat and evaluate patients similar to the one described?

I have experience treating both open and closed fractures. I currently serve as the assistant residency director of orthopedic surgery at a major university hospital, and I teach courses for resident education in the area.

Do you currently prescribe antibiotics for orthopedic trauma?

The timing of antibiotics after open fractures is dependent on the severity of the open fracture. The more severe the soft tissue injury the longer the antibiotics tend to be used. There is always a trade-off with severe open fractures and the need for antibiotics. If the risk of infection and potential amputation is felt to be greater than the risk of ototoxicity from antibiotics, then it may be prudent to use this antibiotic.

How long do most patients require antibiotics after orthopedic trauma?

Generally, the antibiotics will be given pre-op and then for 24-72 hours post-op depending on fracture and soft tissue severity and findings at the time of debridement.

About the expert

This highly qualified expert earned his MD from the University of Toronto. He completed his residency in Orthopedic Surgery at St. Joseph's Hospital and a fellowship in Orthopedic Trauma at Harborview Medical Center-University of Washington. This expert is board certified by the American Board of Orthopaedic Surgery and a fellow of the American College of Surgery and the Royal College of Physicians and Surgeons of Canada. This expert is a member of prestigious societies including the American Association for Surgery of Trauma, the American Orthopedic Association, and the Orthopedic Trauma Association. He has published over 130 peer-reviewed journal articles and over 30 books and book chapter contributions. This expert served as the former Director of Orthopaedic Trauma and Education for the Carolinas Medical Center and is currently an Assistant Residency Director of Orthopaedic Surgery at a major university.