An Oshawa man has lost his leg after several doctors failed to heal a routine leg break, causing the leg to become persistently infected over several years.
The plaintiff broke his right leg after falling down some stairs. He was taken immediately to an Oshawa area hospital where a cast was put on the leg and x-rays were taken. The surgeon performed a closed reduction of the tibia and casted the leg. X-rays showed the procedure went well.
Later, the doctor found he had lichen planus, an itchy rash around the wound, and was not keen to do an open reduction and internal fixation right away, so he discharged the patient and arrangements were made for him to return two weeks later for the procedure.
When he returned for the routine procedure, it turned out to be extremely difficult, as the lateral posterior fragment actually had a separate crack on it and it broke off. The surgeon reduced it proximally with a plate across the fracture. Since the fracture was direct and traumatic, it led to devitalisation of the bone. In such a situation, absolute stability was called for which can only be achieved with compression, which was not done.
The patient was released after a normal recovery, but returned a few days later because there had been oozing through the plaster cast. The x-ray showed no change.
Several weeks later, he was seen again and the dressing was removed. A “foul smelling, purulent discharge” was noted. Antibiotic dressing was packed into the wound and a dry dressing was put on top. Twelve days later, he was seen by a plastic and reconstructive surgeon, who reported a 10cm length wound dehiscence with some tissue necrosis where the surgical wound had split open and the tissue had begun to die. The surgeon removed the skin and sent it to be tested for culture. At this point he had an exposed fracture and plate.
Over the next few weeks and over several more visits, there was more drainage. The wound was open and the bone was showing. The metal was exposed and there was persistent swelling. A reconstructive surgeon noted that his tibia had not united. Osteomyelitis, a bacterial bone infection, had developed and a bone graft was now needed. When he went in for his bone graft, the tibia was still not unified. His wounds were “healing well”, but he was re-admitted twice afterwards for complications from the bone graft and ongoing infection.
Despite all of this, his doctors could not save his leg. It was amputated below the knee after 2 ½ years of persistent infection. Had the reduction and fixation been done when he was initially admitted to the hospital instead of 2 weeks later, his leg would have been saved.
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