[Undislocated fracture of cuneiform I bone complicated by language barrier]

A 30-year-old non-German speaking patient suffered an ankle sprain while playing beach volleyball. Conventional radiography did not reveal any fractures. The patient was treated with a Geisha cast for immobilization and relief and was also informed about pain-dependent weight bearing using an illustrated information sheet. In the course of the healing process the patient consulted the orthopedic department a second time. During a third visit he left before consultation as he felt that the waiting time was too long. Because he disagreed with the treatment he visited an orthopedist who ordered a magnetic resonance imaging (MRI) scan of the patient’s foot. The MRI scan revealed an undislocated fracture of the cuneiform I bone. A control scan was conducted 2 months later and complex regional pain syndrome (CRPS) was diagnosed. The orthopedist ordered treatment based on a therapy with a VacoPed® orthesis. When there was no improvement in the healing process the patient sued the orthopedic surgeon for medical malpractice due to incorrect load and subsequent pain for € 40,000. All courts up to the Federal Court of Germany dismissed the case as no expert witnesses could find any errors in treatment. The court held that the medical information of the non-German speaking patient was sufficient against the defendant’s arguments. It is, however, noteworthy that the burden of proof for sufficient medical information of a patient is always placed on the treating physician.