An article about a digital solution
Unfortunately , we did not know that this will be special…. A digital solution might hae made it easier…
A 45 ys old man was brought to an Emergency Dpt. (ED) by the ambulance after being involved in a road traffic accident as a cyclist.
He was hit by a car that ignored him when it was turning to the right. Luckily, he wore a helmet, so that his head was not affected seriously. However, a slightly displaced and swollen right ankle was obvious on the scene already.
A fracture was assumed and it was splinted. When examined in the ED one could see a scar over the lateral aspect of the ankle. The injured man came from South America and said that he sustained an ankle fracture 15 ys ago. He had surgery in Sao Paulo to fix this fracture at that time.
Further clinical examination brought no evidence of other injuries but bruises. X-rays showed a comminuted fracture affecting the ankle joint, but even worse, the metal implants fixed to the patient´s s bones 15ys ago were directly in the fracture area. He was brought to the operation theatre within 2 hrs. in order to reduce the fracture and temporarily hold it with an external fixation device to allow soft tissues to ebb away. A final surgical open reduction and internal fixation of the fracture including removal of the metal implants from the former operation should take place later.
However, the old metal implants did not allow a proper reduction and therefore the decision was made to take them out now. Unfortunately, the screws that were used in Sao Paulo had a special screw head and none of the tools that were available in that hospital at that time were fitting. The six screws had to be taken out in a time consuming process of overdrilling with a screw tap. Although, surgery was necessary that day, with the knowledge that uncommon screws were fixed in that bone one could have asked for the fitting screw driver by contacting the company or another bigger hospital in the region to help out with that tool.
It is not an unusual situation that surgeons need to know the type of implant that patients were already provided with in former surgical procedures as these
might be the problem themselves or part of it.
Often, special instruments are needed. This concerns artificial joints in the first line but might also be of importance for nails, plates or even screws like in the situation above.
Companies offer “passports” of the implants and hospitals should hand these out to the patient when discharged.
However, these are mostly made of paper and therefore often not available in emergency situations.
A digital solution could be of great help to solve this.
