title: [Incomplete paraplegia after delayed diagnostics of motor function deficits. Severe malpractice?].
abstract: A 72-year-old female patient was transferred to a rehabilitation centre after surgical stabilization of a subtrochanteric femoral fracture. However, adequate mobilization was not possible there and 5 days after transfer deficits in the motor function of both lower extremities were documented for the first time and an initial paraplegia was diagnosed the following day by a neurologist. Magnetic resonance imaging (MRI) revealed the suspicion of an unstable fracture of the seventh thoracic vertebral body 8 days after the initial symptoms, which was confirmed by computed tomography after another 3 days. Surgical decompression and stabilization were performed at a department for neurosurgery 4 days later but incomplete paraplegia persisted permanently. The patient complained about insufficient diagnostic measures at the rehabilitation centre. The expert opinion concluded that it would have been mandatory to investigate the matter of the newly occurring neurological symptoms immediately but this had only been performed after undue delay, which had to be interpreted as a case of medical malpractice. The expert pointed out that it was not possible to provide clear evidence that emergent diagnosis and surgery would have enabled a significantly better outcome.The arbitration board ascertained a lack of examination and argued that prompt and adequate diagnostic measures would have revealed the relevant pathological finding and thus surgery would have been performed immediately. According to the reversal of evidence in favor of the patient it could be assumed that no permanent neurological damage existed when the first neurological symptoms occurred and that emergent surgery at least had the potential to prevent permanent paraplegia. This opinion of the arbitration board is supported by numerous references in the literature.
authors.affiliation: Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Campus Innenstadt, Klinikum der LMU München, Nußbaumstraße 20, 80336 München. markus.regauer@med.uni-muenchen.de
authors.forename: M
authors.initials: M
authors.lastname: Regauer
authors.forename: J
authors.initials: J
authors.lastname: Neu
mesh_terms: D000368:Aged; D057210:Delayed Diagnosis / Q000331:legislation & jurisprudence*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D005858:Germany; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence*; D019300:Medical Errors / Q000331:legislation & jurisprudence*; D010264:Paraplegia / Q000175:diagnosis* / Q000209:etiology*