Disaster Rounds – Fracture Repairs II

Fracture repair outcomes are driven by a series of factors ranging from the origin and severity of trauma to the postoperative management of patients following repair. Even with today’s knowledge, fracture repair may result in unacceptable functional recovery. A poor outcome in a case that sustained a traumatic fracture may find it roots in the inciting trauma, but too often stems from poor judgment by the clinician during one or several of the steps between the time of admission and the occurrence of a complication. It is often said that good judgment comes from experience but that experience comes from bad judgment. One should keep in mind though that the experience from others can help us avoid making bad decisions and that continuous training is paramount to long term success.

Most of the disasters secondary to poor decision making rarely occur because of one single mistake. Rather, it is the accumulation of several smaller mistakes that eventually leads to complications. This phenomenon is well known in general aviation where most accident reports indicate that not a single one decision made by a pilot is the cause of the accident but that a series of poor choices had a cumulative effect that results in an unrecoverable situation. A similar pattern can be recognized in surgeries that results in poor outcomes. While some factors are out of the surgeon’s control, many of them are and these include choices of implants, approach, reduction techniques, postoperative care, etc. Good decision making is not only improved by experience, it is also enhanced by furthering our knowledge of physiology, anatomy, implant biomechanics and reduction techniques. It is probably true that “simpler” cases can heal successfully even if all decisions were not ideal, but it is certainly true that “disaster cases” require optimal management to achieve a successful recovery.  [...]