This case involves a 29-year-old female in Washington D.C. who sustained an ankle injury after falling off a bike in a busy intersection. She underwent an open reduction of her dislocated ankle joint, an excisional debridement, and irrigation of open fractures in her ankle joint ligaments. The patient was given a two-week course of antibiotics and her cultures showed no growth. The patient subsequently developed vestibulopathy leading the patient to be left on disability. It was alleged that the patient developed vestibulopathy secondary to antibiotic toxicity. It was further alleged that changes were made to the pre- and post-op antibiotic protocol dictating that the antibiotics in question should not be prescribed for extended periods. An expert orthopedic surgeon was sought to review the medical records and discuss whether or not the standard of care was followed in this case.
Question(s) For Expert Witness
- 1. Do you routinely treat and evaluate patients similar to the one described?
- 2. Do you currently prescribe antibiotics for orthopedic trauma?
- 3. How long do most patients require antibiotics after orthopedic trauma?
Expert Witness Response E-053604
I have experience treating both open and closed fractures. I currently serve as the assistant residency director of orthopedic surgery at a major university hospital, and I teach courses for resident education in the area. The timing of antibiotics after open fractures is dependent on the severity of the open fracture. The more severe the soft tissue injury the longer the antibiotics tend to be used. There is no official standard as to duration. Generally, the antibiotics will be given pre-op and then for 24-72 hours post-op depending on fracture and soft tissue severity and findings at the time of debridement. There is always a trade-off with severe open fractures and the need for antibiotics. If the risk of infection and potential amputation is felt to be greater than the risk of ototoxicity from antibiotics, then it may be prudent to use this antibiotic.