Sometimes such a migration may cause serious, even fatal injury to important organs, vessels,etc. Could the primary surgeon be subjected to litigation process ?
Thank you, Dr. Rashad for your answer. You are right that such a question is difficult to answer. But , unfortunately, migration happens and can cause serious injury. I will give a hypothetical case. Sternum is often closed using wiring after cardiac surgery, anterior mediastinum surgery, funnel chest surgery, etc.
Imagine that wires break some months after surgery and stab the heart which can be a very severe injury. Is the primary surgeon to blame, if the surgery has been properly done ? Or we have to rely upon literature data for percentage of wire breakage and migration ?
Very interesting and complex question regarding medical responsibility... Many options are available! Regarding law practice, if the initial osteosynthesis doesn't fit the golden standards or the security requirements, experts (and judges) could admit (and probably will in France as well as in US) the principle of causal responsibility involving the initial surgeon for "fault" or "error" (fault, damage and direct as well exclusive relationship between these items). It's rather easy to do so in western Europe and in the US... If not, the second option is not much more satisfying and the lack of survey requirements (or patient's information) could be admitted by the Court to involve the initial practitioner's responsibility... That's the point of view of lawyers, but it's not mine even if I've been expert for a while! It's rather easy to say something, anytime about anything and criticize the work previously done, whatever good or not. But we certainly all have cases we're not so proud of and we know how things may sometimes be complicated, may turn badly or more simply goals hard to achieve. I remember a case that perfectly illustrate this situation: a patient admitted in emergency in intensive care unit for "heart attack" a few years after K-Wires stabilization of his sterno-clavicular joint. One of the pins had migrated in the mediastinum close to the cardiac cavities and was suspected to be responsible for the death that occured a few hours later despite the heavy resuscitation performed. In fact, the extended coronary thrombosis truly responsible for the death had strictly no relationship with the pin migration...
Medicine remains an art! Thank you once more for this excellent and interesting question... The best to U all
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