[Incorrect aftercare of a surgically treated metatarsal fracture]

A 60-year-old patient suffered an ankle distortion resulting in a comminuted fracture of the fifth metatarsal. On the same day the accident occurred the patient presented to an emergency department and immediate operative treatment of the fracture was performed by intramedullary Kirschner wires with closed reduction and internal fixation. The aftercare was carried out on an outpatient basis by a registered orthopedist in accordance with the surgeon's instructions. In the radiological control 14 days after surgery a dislocation of the fracture was detected and 1 week later a rectification operation was carried out in a second clinic with removal of the Kirschner wires, open reduction and internal fixation with a locking plate. The patient suspected inadequate treatment by the first clinic, which in turn did not accept any inadequacies in the surgical treatment or the aftercare. In the subsequent legal dispute the appointed experts came to the conclusion that an initial good fracture position was achieved but that the aftercare treatment with a forefoot relief shoe was inadequate for the type of internal fixation chosen. The arbitration board came to the conclusion that the multifragmented fracture situation was treated by a questionably stable osteosynthesis using Kirschner wires. This should have required a very strict aftercare with partial weight bearing on crutches and immobilization in a stable orthosis or cast.