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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 30684
Experience:  Over 20 yrs of Family Practice
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I broke my leg 6-15-13 & had surgery on 6-21-13. Two plates

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I broke my leg 6-15-13 & had surgery on 6-21-13. Two plates were put on both bones and one of the plates has been exposed since July 25th. The doctor finally gave me three options on 9-4-13. I called his office on 9-6-13 and told his assistant my decision and as of 9-10-13 no call back.
Hi--what exactly do you mean by a plate being exposed and what were the options given you? Is you question which is the best option?
Customer: replied 3 years ago.

I can see the plate and about 5 screws. Doctor said we could leave this the way it is until bone has completely healed. Remove plate and hope I don't injure the bone and third is to have plate removed and an exterior afixator (can't spell) to support the bone.

So the plate is secure and intact? If so there'd be no need for an external fixator Teresa
Customer: replied 3 years ago.

The plate has to be removed, once it is exposed it becomes contaminated and has to be removed. I am on antibiotics and have been since 6-15-13 and not sure when they no long will work. If I took the 1st option I'm taking a chance that the antibiotics continue to work.

I see. So you want to know if you should continue the antibiotics or remove the plate now?
Customer: replied 3 years ago.

I want to the plate removed! Should I have the exterior afixator?

Well, how well have the fractures mended--is there good callus formation--extra bone growth in the areas of the fractures?
Customer: replied 3 years ago.

As of 9-4-13 there is no good callus formation.

OK--in that case you need the external fixator. In general, hardware like that isn't ever removed unless it becomes a problem but without the callus formation the fractures are still weak and it's likely until they firmly mend that any weight on the leg without the plates might refracture the bones. External fixators are certainly no fun, Teresa, but you shouldn't take the chance of the extra complications of refracturing the bones.
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Customer: replied 3 years ago.

My other question is when I called the doctor and said I did not like the way the incision was healing (before I could see the plate) could he had done something to prevent this?

Well tell me more about this--did the incision open up after it had been closed?
Customer: replied 3 years ago.

I had surgery on 6-21-13 and about 7-20-13 I realized the incision outside of my leg was healing, but not the inside especially over the ankle bone was not do as good. It was not open, not until about 7-25-13.

Was the skin OK or was it looking like it was thinning and maybe dying? What exactly do you mean by there was a problem with the inside?
Customer: replied 3 years ago.

I don't know what dying skin looks like. The outside incision was 90% healed, where the inside was only 15% healed. If I could see a scar I considered it healed and the inside there was very little scar.

Not sure I understand. How could you tell the inside was only 15% healed?
Customer: replied 3 years ago.

The incision is about five inches long and 15% was closed, which left a scar, the rest was still bloody looking.

OK--so basically a lot of the incision had come apart and was open? How was that treated when it first happened?
Customer: replied 3 years ago.

Doctor did not give my any additional instruction, just to keep clean and watch. If I had flu like systems or could see hardware give him a call.

So he saw this when it first happened?
Customer: replied 3 years ago.

He saw this around 7-24-13

And what did it look like then?
Customer: replied 3 years ago.

I took a video with my cell phone on 7-25-13 I could send you e-mail. So you can see.

Sorry we can't use email here. You could post it on Snapfish, Imageshack or PhotoBucket or Utube and give me the link
Customer: replied 3 years ago.

I'm not computer smart or smart at all. All I know is that we relied on the doctor to give us good advice & instructions. I'm 57 and my husband 60 and we have never had a broken bone or surgery. I appreciate your help, but think I will wait for the second opinion before I have this doctor do the next surgery.

Well, just so you'll know, it sounds to me as though the incision opened all the way to the plate and it should have been resutured closed before the infection set in. I can't say for certain that this doctor was negligent since I wasn't there, but I think you have the right idea for getting a second opinion
Customer: replied 3 years ago.

Thank you!

Let me know how it goes Teresa
Customer: replied 3 years ago.

I had doctor appointment with new doctor on 9-13-13 and had surgery on 9-16-13. New doctor removed plate and did not feel the external fixator was required. Bone was strong enough. New doctor put a wound vacuum on wound to help it heal, but thinks I my need skin graph. I fell much better with this doctor. Thank you!

Glad to hear it Teresa and you probably will need the skin graft. Keep in touch

Customer: replied 3 years ago.

Dr. Chip would I have a law suit against the first doctor? I'm now on IV antibiotics for at least 7 days. The bone did have infection and I learned today to change the IV bag. When I went to the new doctor on Friday Sept. 13, he asked if the wound center was treating the big wound over the ankle and told him no. They were told to only treat the smaller wounds because the plate would have to come out. I feel the old doctor and wound center were not telling how serious the wounds were.

Customer: replied 3 years ago.

Dr. Chip could this have been prevented by the first doctor being aggressive with some treatment?

Sorry for the delay Teresa--what have the new doctors told you about the whole situation?
Customer: replied 3 years ago.

New doctor did surgery on Monday 9-16-13, he took out the one plate and did not put on external fixator. He put me on a wound vacuum and an antibiotic thru an IV. I saw him today and saw the incision, looks a lot better. Where I did see the hardware and five screws, I do see the bone but fresh blood and it looks clean. Next week on Monday I go to the wound center to change wound vac and then Thursday to see doctor. Very happy with this doctor

Customer: replied 3 years ago.

New doctor did not put on external fixator, he thought bone was strong enough. He did put a wound vacuum on wound and have to go in about twice a week to have dressing change. Went in on Friday wound looked better without hardware, but could see bone. Wound vac seems to be working, doctor was pleased. I go back next week, once to wound ctr and once to his office. Hopefully this will prevent skin graft.

Sorry Teresa--I had to be off. But what were you told about the problem that occurred with the first incision?
Customer: replied 3 years ago.

New doctor did not say what was wrong with first incision, he just asked me to tell the story and when the old doctor last saw the wound and what did he do? I saw old doctor 9-4-13 and did nothing but gave me the three options and blame me because I had not completely quit smoking. I told the new doctor the old doctor never did anything, like clean wound, he referred me to the wound center, but they were told not to work wound that you could see the hardware. New doctor did not understand why they did nothing with that wound. New doctor said he has had incision come apart but never this bad or for this long. New doctor said he would clean incision and new stitches . New doctor said he did not want to do the surgery because he did not want to cleanup someone else's mess. I asked wound center if me smoking caused this wound, they said no, but smoking slows the healing process. I have quit as of 8-15-13. The old doctor said a different doctor would have to put the external fixator on because he did not put them on. He said I would have to have a UA done before surgery and through recovery to make sure I was not smoking and if I had smoked I would be kicked out of clinic.

OK, Teresa--I thing there's a good probability that this could have been prevented with proper treatment from the first surgeon and it didn't have to do with your smoking. I would suggest you present your medical records to a malpractice attorney to see if you may have a legitimate case
Customer: replied 3 years ago.

Do I have to get a statement from new doctor stating he thinks old doctor may have messed up?

No. An attorney can show the records to a surgical medical expert and they can determine if there's medical negligence here.
Customer: replied 3 years ago.

Thank you! Hopefully I can find an attorney to take this. I will let you know when I can walk again and how everything works out.

No problem--usually malpractice attorneys will look at the case for free to decide if there is a legitimate case there Teresa. Definitely please keep in touch
Customer: replied 3 years ago.

Dr. Chip, I thought I would let you know that the new incision from surgery on Sept. 16th is almost healed. The wound over the ankle bone is still not closed, but I still have the wound vacuum on the wound and I am scheduled to have a flap done on Oct 21st. It does look better than 1st surgery. Still not walking.

Good news Teresa--give it time
Customer: replied 3 years ago.

Dr. Chip, Just thought I would let you know that my second doctor had me go to OHSU and have a flap done one Nov. 6th. The flap was taken from my left thigh, the incision on the thigh is healing and the flap is doing good. Starting to put weight on left leg, but feel like I have to learn to wake again, first time was over 57 years ago, so can't remember how it felt.

I did contact an attorney, but he wants to talk to second doctor and I don't want to put him in that position. Do you know any medical attorney in Idaho?

Really you just need a medical expert to review your case Teresa--no need for the second doctor. Sorry, I don't know any malpractice attorneys in Idaho. It is like learning to walk again and it happens to the astronauts on the space station when they return to Earth. Sounds like great news so take it carefully and you'll be jogging before too long
Customer: replied 3 years ago.

Thank you very much!

Any time