Orthopaedics: leg and arm procedures
1) Insufficient fixation of ankle fracture
A patient fell over and suffered an ankle fracture that was not fragmented. The fracture was treated by way of surgery and the fractured site was fixed with a plate and screws. During the follow-up period, the healing of the fracture was slow and the ankle was painful. A control X-ray indicated that the fixation of the fracture had not succeeded sufficiently well. The fixation could not prevent an incorrect position from emerging again between the fractured pieces. Had the fixation been carried out appropriately, fracture healing would have been faster and the outcome better.
The treatment of the ankle fracture by way of surgery and metal fixation was medically indicated. However, the level of professional competence of a healthcare professional performing fracture repair surgeries was not achieved with regard to the technical performance of the operation as the fixation of the fracture remained lacking.
The patient was compensated for the personal injury caused by the prolonged healing and outcome that was poorer than expected.
2) Femoral fracture in connection with joint replacement surgery
A patient underwent hip replacement surgery due to arthrosis. A fracture of the upper extremity of femur occurred during the procedure, and resurgery was necessary because of it.
The hip replacement surgery was medically justified to treat the symptoms of arthrosis. The surgery was carried out technically in an appropriate way. A fracture of the upper extremity of femur is always possible in connection with joint replacement surgery. In this case, the fracture could not have been avoided in spite of appropriate treatment. The fracture was observed and the procedures required for treating it carried out during the surgery.
This was not a patient injury eligible for compensation.
1) Wrist fracture, appropriateness of cast treatment
A patient suffered from a fragmented yet non-displaced fracture of the radius, which was treated by casting. Deterioration of position could be observed in the initially non-displaced fracture a week later, and another week later it had deteriorated slightly more. However, the position still remained acceptable. Cast treatment was continued until the ossification of the fracture took place. Pain, weakness, limited range of motion and incorrect position remained in the wrist.
The treatment of the lower extremity of the radius is primarily conservative, i.e. non-surgical. The aim is to return the position by setting it in place (repositioning) and maintain the position with a cast. Surgical treatment is considered if the position of the fracture deteriorates significantly during the cast treatment. The position that can be considered acceptable varies depending on factors such as the patient's general health, age, severity of the fracture and the requirements for the use of the arm.
Even if the treatment outcome of a radius fracture is good, the wrist does not necessarily become symptomless after fracture. A wrist that has fractured into fragments does not usually return to the level of a completely health wrist in terms of functionality.
In the case of the patient, cast treatment was the appropriate choice of treatment, and follow-up was carried out in an appropriate manner. The symptoms remaining after the treatment are the result of both a slight incorrect position and the underlying injury (fragmented fracture). The case does not constitute a compensable patient injury.
2) Wrist fracture, screw fixation, screws extending to the joint
A patient suffered a fracture of the wrist, or radius, when falling over. The fracture was initially treated by casting, but the position of the fracture deteriorated during follow-up. Therefore, it was decided to operate it and fix the fracture using screws. A follow-up X-ray of the fracture indicated that the fracture fixation screws extended to the joint. The patient was operated on again, removing the fixation material.
The fracture operation on the patient was medically indicated, as the position of the fracture had deteriorated significantly during the cast treatment, and cast treatment probably could not have achieved a good outcome. However, the level of professional competence of a healthcare professional performing fracture repair operations was not achieved with regard to the technical performance of the operation. The lengths of the fixation screws should have been selected so that they would not extend to the joint.
The patient was compensated for personal injury caused by the resurgery.
3) Carpal tunnel release surgery, resurgery
A patient had compression of the median nerve in both wrists, causing pain and loss of strength, and therefore he underwent median nerve release operations on both wrists. Recovery was not normal after the surgery. The patient was operated on again, finding that some transverse carpal ligament had remained unopened in both arms and the release of the median nerve had not happened all the way.
The operation on the wrists was medically indicated to release the compression of the median nerve. However, the level of professional competence of a healthcare professional was not achieved as the ligament had not been opened all the way.
The patient was compensated for personal injury caused by the resurgery and prolonged recovery.
4) Carpal tunnel release surgery, clumsiness of the thumb after surgery
A patient suffered symptoms and loss of strength in the left wrist due to compression of the median nerve. He underwent a median nerve release surgery, after which his left thumb remained clumsy. More detailed examinations did not indicate nerve damage, and the post-surgery condition was normal.
The operation on the wrist was medically indicated to release the compression of the median nerve. The technical implementation of the surgery was also appropriate. The clumsiness remaining in the thumb is a possible consequence that is always associated with the operation, and it could not be avoided in spite of the appropriate implementation of the procedure.
The case did not meet the criteria for an injury compensable under the Patient Injuries Act.
5) Diagnosis delay of finger tendon injury
A patient had suffered a laceration from glass in the middle finger. At the ICU, the doctor estimated the wound to be superficial and closed it with sutures. During the follow-up period three weeks after the trauma, it was found that the flexion of the finger was not normal. Tendon injury, probably caused in connection with the original laceration, was found in the finger. The tendon injury was repaired in an operation by a hand surgeon.
The diagnosis of the finger tendon injury was delayed. The tendon injury could have been diagnosed with examinations of the movement of the finger already when the wound was examined.
Because the diagnosis and treatment were delayed due to the examinations being insufficient, the patient was compensated for personal injury caused by the delay. However, the hand surgery would have been necessary in any case, even if the diagnosis was made earlier, so the operation was not compensated for under patient insurance.