[Consequences of uncritical indication assessment for hardware removal]

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Medical Malpractice Litigation

Background:

• A 43-year-old woman experienced a severe ankle dislocation and distal fibular fracture.
• Initial treatment involved external fixation followed by internal fixation with a locking plate and vacuum-assisted wound closure due to soft tissue compromise.

Observation:

• Despite prolonged wound healing and skin grafting, a subsequent hardware removal attempt resulted in an iatrogenic fibular fracture.
• The patient developed a methicillin-resistant Staphylococcus aureus (MRSA) infection, leading to a medical malpractice complaint.

Findings:

• An expert opinion found medical malpractice regarding the indication for hardware removal.
• The arbitration board criticized the surgical technique and concluded hardware removal was contraindicated due to pre-existing osteoarthritis and the critical wound condition.

Implications:

• Leaving the hardware in place, with proper indication assessment, could have prevented iatrogenic fracture and delayed wound healing.
• This case highlights the importance of careful surgical planning and patient selection in orthopedic hardware removal, especially in complex cases with comorbidities.