Manipulation Under Anesthesia resulting in peroneal nerve injury (Case #112)

• Medical Probability: 6 / 10
• Medical Error Summary: An MUA in such cases is definitely a shared decision process after a thorough discussion of the relevant risks and complications. Nerve and vessel damage and fracture are certainly risks of an MUA in ...
• Causation Probability: 6 / 10
• Causation Summary: I do feel there is causation as the peroneal function by assumption was fully functional prior to the MUA. The real issue may be as to how the injury was managed after the occurrence.
• Expert Summary: I am a board certified sports medicine fellowship surgeon with a large and very high volume tertiary referral practice. I manage difficult cases involving complex knee pathology on a daily basis.
• Similar Summary: I routinely am referred complex knee cases that require complex surgical planning. Stiff postoperative knees from major reconstruction or after TKR or routinely sent to me for definitive management. ...

Significant malrotation in lower extremities following two ORIFs for bilateral femur fractures (Case #173)

• Medical Probability: 7 / 10
• Medical Error Summary: The basic principles in the treatment of fractures of the femur include restoration of position and alignment, maintenance of length, immobilization until bony union occurs, and restoration of normal...
• Causation Probability: 7 / 10
• Causation Summary: The substandard care of the bilateral femur fractures resulted in multiple surgeries and left the patient with dysfunctional limbs with rotational abnormalities and a residual LLD.
• Expert Summary: As a board certified orthopaedic surgeon in practice for 25 years and with 2 decades of military service (ortho), I have managed a high volume of long bone fractures in isolated and multi trauma patie...
• Similar Summary: I routinely see long bone tibia and femur fractures in my practice.

No informed consent for microfracture? (Case #174)

• Medical Probability: 9 / 10
• Medical Error Summary: The consenting process here as presented did not support the surgeon doing any cartilage restoration surgery (microfracture, MACI, OCA, etc.).
• Causation Probability: 9 / 10
• Causation Summary: Informed consent must thoroughly explain the operative techniques that are planned during the upcoming surgical procedure. The rehabilitation program details and requirements must also be explained to...
• Expert Summary: I am a sports medicine fellowship trained board certified orthopaedic surgeon with an extensive tertiary national referral knee and shoulder joint restoration practice. I perform a very high volume o...
• Similar Summary: I manage similar cases on a daily basis in my practice. I perform more advanced cartilage restorative procedures (e.g., osteochondral allografts) than any other clinic in the United States.

Hip replacement and medical clearence (Case #242)

• Medical Probability: 9 / 10
• Medical Error Summary: Preoperative clearance is more important than the elective surgery. itself. Obtaining preoperative clearance is a responsibility of both the referring Ortho surgeon and the PCP performing the clearanc...
• Causation Probability: 9 / 10
• Causation Summary: The most likely cause of the peri-op V-Tach was the laboratory and ECG abnormalities
• Expert Summary: I am a board-certified orthopaedic surgeon with 26 years of clinical experience. I have been obtainng preop clearance for all 26 years.
• Similar Summary: I encounter cases such as this on a daily basis in my practice.

Possible lunate injury from chondroplasty - caused CRPS? (Case #298)

• Medical Probability: 8 / 10
• Medical Error Summary: Over aggressive debridement and chondroplasty somewhat of a case of a marginal surgeon getting marginal results unless preop MRI imaging confirms normal/near normal 3-D cartilage surface architecture ...
• Causation Probability: 7 / 10
• Causation Summary: Inital arthroscopy images will likely detail minimal chondral changes, yet final arthroscopy images and those from 2nd surgeon will confirm surgeon derived lesions, (grade 4).
• Expert Summary: I am a board-certified sports fellowship trained orthopedic surgeon that is highly skilled at advanced arthroscopic surgery of the upper and lower extremities. I can review the subtleties of arthrosco...
• Similar Summary: I see over exuberantly debrided joint surfaces via arthroscopy on a regular basis as my tertiary referral orthopaedic sports practice is mostly revision cases

Orthopedic surgeon (upper extremity specialist) failure to perform proper physical assessment or MRI (Case #300)

• Medical Probability: 3 / 10
• Medical Error Summary: The PA appeared to perform enough of an examination to determine the patient did have impingement which does incorporate tendinosis and even partial thickness tearing. Appropriate nonop treatment was ...
• Causation Probability: 3 / 10
• Causation Summary: same as above. No one can know when the final fibers of a partially torn cuff or distal biceps insertion site will fail/rupture.
• Expert Summary: I perform an extremely high volume of rotator cuff related surgery- up to 6-8 repairs per week throughout the year and treat at least that many patients every day in clinic. I teach colleagues around ...
• Similar Summary: This is a red swan type of incident. In hindsight, I am certain pathology would have been visualized had an MRI somehow been obtained, but, as I said, that IS NOT the standard of care based upon our o...

TKA Revision causing popliteal artery occlusion requiring suction thrombectomy and stent placement. with angioplasty (possible injury to popliteal artery by prosthetic) (Case #362)

• Medical Probability: 8 / 10
• Medical Error Summary: The lateral fluoroscopic image included in the case vignette reveals significantly greater than 1 cm of overhang of the revision total knee tibial tray that appears to directly impinge upon the poplit...
• Causation Probability: 9 / 10
• Causation Summary: It is more likely than not that the oversized/overhanging tibial prosthesis caused the popliteal artery damage that resulted in the IR procedure. The solid cornered metallic prosthesis kinks the norma...
• Expert Summary: I perform knee arthroplasty (mostly medial, lateral, and patellofemoral) and complex knee stabilization cases (proximal tibial osteotomies, plateau fracture fixation and knee dislocation surgery) on a...
• Similar Summary: In the trauma setting, I have managed such cases on referral and helped manage the extremity in conjunction with vascular surgery throughout my career.

55yo Male missed/delayed Lisfranc Dx in R foot leading to multiple complications. (Case #387)

• Medical Probability: 8 / 10
• Medical Error Summary: This case really hinges on a delay in the diagnosis, and it is missed, but eventually picked up. The real question. is:. Could we have anticipated that an expectedly better outcome could have occurred...
• Causation Probability: 8 / 10
• Causation Summary: Had the injury been diagnosed and treated appropriately earlier, the expected outcome, more likely than not, would have been better.
• Expert Summary: I treat traumatic foot and ankle injuries as a head team physician for a busy University Program and teach and see patients with over 28 years of clinical expereince
• Similar Summary: Missed bad foot and ankle injuries are routinely referred to my busy sports clinic