The Panel did not find any literature advocating that patients be admitted because of bad weather
A 59-year-old male patient slipped on ice while getting off of a bus and fell onto his left knee, suffering what would later be diagnosed as a left quadriceps tendon tear. He was evaluated in an emergency department by the emergency physician, who noted that the patient was unable to extend his knee and was unable to bear weight.
Explore This IssueACEP News: Vol 29 – No 09 – September 2010
An orthopedist was consulted and evaluated the patient in the emergency department. The orthopedist performed an arthrocentesis, put the patient in a knee immobilizer, and gave the patient instructions for outpatient follow-up.
Crutch training was performed by the emergency nurse and the emergency physician. During training at one point, the patient had some difficulty in ambulating, almost fell backward, but maintained his balance using his injured leg. After 20 minutes of crutch training, the physician noted that “I think the patient will do well with crutch practice.”
The patient later stated that he informed the hospital staff about concerns he had with his ambulation and with the bathroom in his home being on the second floor. He was advised that he would have to go up and down stairs in his home “on his butt.”
The emergency physician discussed crutch use versus walker use versus wheelchair use with the patient, and the patient decided to leave with crutches. The emergency physician gave the patient a prescription for a wheelchair if the patient became uncomfortable using crutches. The patient’s pain rating on discharge was 3 of 10.
While getting out of his car after discharge, the patient slipped on the ice, fell backward, and fractured his right ankle.
The patient filed a lawsuit against the hospital and the physician for failing to admit the patient to the hospital to repair his quadriceps injury on his first visit, alleging that the patient’s “unsafe” discharge was a direct cause of the patient’s ankle fracture.
Standard of Care Panel Review
The medical literature recommends early surgical repair of complete quadriceps tendon ruptures. There is no standard on when that surgery must be performed. Some sources recommend immediate repair, while other sources state that surgery may be delayed up to 1 week.
Immobilization and close outpatient orthopedic follow-up is appropriate even in patients who have suffered a complete quadriceps tendon rupture.