Poor clinical results

A forty-three-year-old woman presented with problems following ankle surgery. The initial diagnosis was idiopathic avascular necrosis of the talus. An arthrodesis of the ankle was performed with external fixation and an iliac crest bone graft. A nonunion developed at the fusion site, and the patient reported persistent pain and an inability to bear weight. She sought a second opinion and was told that the attempt at fusion had failed. The treatment options were explained to her. She underwent débridement of the nonunion and a tibiocalcaneal arthrodesis with internal fixation. Postoperatively, the patient had a solid fusion and was able to bear full weight without pain. Although ultimately satisfied with the result, she repeatedly expressed anger about the original care and asked if malpractice had been committed.