Ortho surgeon loses lustre for ignoring the ‘golden hour’

  • Posted on: September 14, 2023

The patient was badly injured in a road accident. He sustained injuries on both legs and was rushed to a hospital.

The orthopaedic surgeon diagnosed fracture of upper tibia, and for some reason left the hospital without adopting a proper line of treatment. After about twelve hours, the patient was referred to another hospital where he was diagnosed with fracture of upper tibia, lateral condyle with vascular compromise, severe swelling, cold limb, absent of toe movements and sensation over the left ankle and foot.

Colour doppler test was performed which revealed thrombosis of tibial arteries. Unfortunately, left leg below knew had to be amputated. The patient continued to suffer pain and complications at the amputated site for three subsequent months.

He sued the orthopaedic surgeon. It was alleged that the doctor did little in providing medical treatment, other than applying POP and prescribing some painkillers.

The doctor argued that he attended the patient on time, applied AK POP slab and kept him under observation. When the patient complained of severe burning sensation in left lower limb, the medical officer noticed that anterior distal pulse was not present and left foot was colder than the right one. Upon receiving this information, over the phone, the patient was advised to shift to a higher centre for immediate intervention by a vascular plastic surgeon.

Where did I go wrong, questioned the doctor.   

The Commission gave an apt response to his question, as it observed the following:

“Admittedly, Doppler test was not available in the first hospital. A medical expert has opined that only due to delay at the first hospital, amputation was necessitated. As per treatment of fracture of tibia, protocol is necessary to assess neuro-vascular status of the limb and fracture. In such circumstances, it was necessary to close and observe the fractured limb in view of possibility of compartment syndrome or vascular insufficiency. In case of suspicion, Doppler test is very crucial in first six hours of the injury. The reason for amputation of limb is delay of twelve hours. First six hours are the golden hours from the time of injury to manage the patient”. 

“Moreover, it is to be observed that compartment syndrome will not affect the fractured site in every case of a closed fracture. At the same time, one cannot say with any definiteness that it will not come to a patient. When patient was admitted with a closed fracture and when he complained of pain, he should have been referred earlier to another equipped hospital. The orthopaedic surgeon should have advised Doppler test, or in the alternative should have referred the patient”.

The failure to advise Doppler test, and to refer the patient on time to another hospital cost the doctor and hospital dearly as they were both held negligent and ordered to pay compensation to the patient.

Source : Order pronounced by Telangana State Consumer Disputes Redressal Commission on 7th August, 2023.