Brief description of the condition:On August 27, 2019, the plaintiff was admitted to Hospital A for hospitalization** due to traumatic injuries, and the clinical diagnosis was "1open comminuted fracture of the distal tibia and fibula of the left tibia; 2.Left ankle soft tissue contusion", and was discharged on October 9, 2019 after "open reduction and internal fixation of distal tibia fibula comminuted fracture" in the hospital under general anesthesia on September 6, 2019, and was discharged from the hospital with a diagnosis of: 1open comminuted fracture of the distal tibia and fibula of the left tibia; 2.soft tissue contusion of the left ankle; 3.Necrosis of the left ankle**. On January 26, 2022, the electromyography examination of Huashan Hospital showed the electrophysiological manifestations of severe damage to the superficial peroneal nerve at the left malleolus trauma, and the active recruitment response of the muscles examined in the left lower limb was weakened, and there was no obvious abnormality in the nerve conduction function test.
Court Hearing:The "Judicial Appraisal Opinion", the "Analysis and Explanation" section states: "1. Characteristics of the caseThe appraised person, Wang, female, 56 years old, was in good health in the past. On September 6, 2019, he underwent 'open reduction and internal fixation of distal tibia and fibula comminuted fracture of the left tibia and fibula'** surgery to take the anterolateral incision, and on the first day after surgery, there were changes such as redness and swelling and blue color of the incision site and the surgical incision site, and on September 23, 2019, the redness and swelling of the incision ** were slightly relieved, and when he was discharged from the hospital on October 9, 2019, there was still a small piece of wound ** blackened and the surgical incision was healed. On January 26, 2022, the electromyography examination of Huashan Hospital showed the electrophysiological manifestations of severe damage to the superficial peroneal nerve at the left malleolus trauma, and the active recruitment response of the muscles examined in the left lower limb was weakened, and there was no obvious abnormality in the nerve conduction function test. 2. The distal end of the left tibia and fibula was comminuted and fractured by the external injury of the appraised person Wang, and the medical record recorded that 'a large abrasion was seen on the inside of the left malleolus, and the ** wound was about 1cm....Combined with the results of the radiograph, it is roughly similar to the fracture site, and it is difficult to rule out the situation that the fracture end or fracture hematoma communicates with the outside world through the soft tissue wound, and there is no obvious fault in the diagnosis of 'open fracture'. Among them, the left tibial fracture spiral fracture line was accompanied by mild separation and displacement, and at the same time accompanied by the fracture of the distal end of the left fibula (lateral malleolus), which was more likely to be caused by rotational rollover violence, and had an indication for surgery. However, the doctor is at fault as follows:1Due to the soft tissue contusion on the medial side of the middle and lower part of his left lower leg, the surgical incision was selected to avoid this area to prevent infection. However, although the above-mentioned soft tissue injury sites were avoided by the doctor's choice of the anterolateral incision, after the anterolateral incision was selected, necrosis and delayed healing of the postoperative incision site still occurred, and at the same time, necrosis also occurred locally in the soft tissue injury, and the time was more than a month, suggesting that it was related to the high suture tension of the incision and local edema. 2.The anterolateral incorpois was selected for surgery, and the superficial peroneal nerve was exposed during the operation, and the hospital clearly recorded the protection of the superficial peroneal nerve in the surgical records, but the evaluator reported that on the second day after surgery, he had symptoms of superficial peroneal nerve damage such as numbness and hypoesthesia in the dorsum of the foot on the second day after surgery, and the follow-up electromyography also showed the electrophysiological manifestations of severe damage to the superficial peroneal nerve at the left malleolus trauma, and the superficial peroneal nerve injury and this operation had a temporal continuity and a logical causal relationship, suggesting that the doctor had a negligent behavior of iatrogenic injury to the superficial peroneal nerve during the operation. There is a causal relationship between the wrongful act and the harmful consequences of the patient, and the fault is the whole cause; 3.The medical history records did not mention the changes in the superficial peroneal nerve injury of the left lower limb, and the failure to detect the superficial peroneal nerve injury in time and take timely remedial measures led to the loss of the patient's opportunity to remedy**, and the hospital was at fault for this. 3. In accordance with the provisions of the "Standards for Grading the Degree of Disability Caused by Human Injury", the loss of left ankle joint function is more than 50% (less than 75%), and the degree of disability caused by structural injury is graded as a grade 10 disability; There is a causal relationship between superficial peroneal nerve injury and delayed healing of surgical incisions, and the causal force is preferably mild to minor.
The court ordered the doctor to compensate the plaintiff 40% of the reasonable losses, totaling 53750,000 yuan.
Brief Analysis:The doctor forcibly sutured during the suture, resulting in excessive local tension, resulting in a series of complications, poor healing of the incision, and fault; If it is found difficult to suture during surgery, a tension-reducing suture should be used to ensure smooth healing of the incision. The surgical records clearly recorded the protection of the superficial peroneal nerve, but the evaluator reported that on the second day after surgery, he had symptoms of superficial peroneal nerve damage such as numbness in the dorsum of the foot and decreased sensation, and the follow-up follow-up electromyography also showed the electrophysiological manifestations of severe damage to the superficial peroneal nerve at the left ankle trauma, which could not be explained, and probably only the surgeon knew. The postoperative ward rounds and disease course records did not mention the symptoms of nerve damage, and once again lost the possibility of early **, which eventually led to grade 10 disability. At the heart of the above mistakes is the doctor's duty of care and responsibility, hoping to learn a lesson.
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