Legal Considerations in Orthopaedic Practice

(OBQ18.176) Failure of effective communication in the surgical setting has been associated with what?

(OBQ18.2) During a new patient office visit, a physician asks an initial open-ended question to the patient. On average, how much time elapses before the physician redirects the patient's initial statement of concern?

(OBQ13.263) An 82-year-old osteoporotic woman undergoes total hip arthroplasty for osteoarthritis. During implant trialing, a crack is heard. Intraoperative fluoroscopy reveals a long, spiral fracture of the distal femur. The fracture is reduced and fixed with an anatomic locking plate. The rest of the total hip arthroplasty proceeds uneventfully. Following surgery the surgeon has a meeting with the family and apologizes and provides full disclosure, accepts responsibility, provides a detailed explanation as to what happened, and gives reassurance that steps will be taken to prevent recurrences. This communication approach will most likely

(OBQ13.77) Communication breakdown is the leading cause of which of the following?

(OBQ13.49) A 14-year-old patient has sustained a complete ACL tear of his right knee. Which of the following options has shown to be the most limiting factor for access to pediatric orthopaedic management in the United States?

(OBQ13.250) A 38-year-old female with a grade IIIB open tibia fracture is scheduled to undergo definitive fixation and subsequent flap coverage with the orthopaedic and plastic surgery teams. She is met in the pre-operative area by the surgical intern and paperwork is completed per institutional protocol. She is then brought back to the operating room. Which of the following is true regarding the pre-surgical timeout?

(OBQ13.178) A 25-year-old Spanish speaking male presents to the emergency department 6 hours after sustaining the injury seen in Figure A. He is grossly intoxicated and screaming in pain. Physical examination reveals a closed injury with overlying muscular compartments that are extremely firm to palpation. After sedating the patient, measurements of the intracompartmental pressures were all found to be >75mmHg. His wife is Spanish speaking and expected to arrive to the hospital in 2-3 hours with a relative to help with translation. No medical translator is available. You attempt to outline the risk and benefits of surgery to the patient, but the he repeatedly interrupts you and yells out ,"No surgery!". An English-Spanish speaking friend is with the patient and says that he has known the patient for over 2 years and will help with any decision making. What would be the next most appropriate step in the management of this patient?

(OBQ13.159) The origin of bovine derived grafts is particularly important to which of the following religious groups?

(OBQ11.217) Which of the following statements is inaccurate in describing the origin and purpose of the Institutional Review Boards (IRB)?

(OBQ11.197) As part of the "time-out" protocol recommended by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), all of the following are required EXCEPT?

(OBQ11.157) Which of the following determines when a patient involved in a Worker's Compensation claim is allowed to choose their treating physician?

(OBQ10.267) Effective communication between physicians and patients has been shown to affect all of the following EXCEPT?

(OBQ09.249) A 13-year-old girl with a displaced proximal tibia fracture is brought into the emergency department by her adult cousin. The fracture needs surgical management. The child is living with her cousin's family while her parents are in Germany. While the child speaks fluent English, her cousin and her parents are German-only speaking. How should you consent this patient?

(OBQ09.159) A 65-year-old man sustains the reverse obliquity intertrochanteric fracture as shown in Figure A. He undergoes fixation with a sliding hip screw construct and his 3 month postoperative radiograph is shown in Figure B. His treating surgeon states that the "standard of care was performed for his fracture pattern" and the patient asks you as a consulting surgeon for a second opinion. Each of the following statements regarding your legal and ethical obligations as the consulting surgeon providing a second opinion are true EXCEPT?

(OBQ08.206) A patient is consented for a right wrist open reduction and internal fixation. After the patient is prepped and draped, a skin incision is made. It is recognized intra-operatively, however, that a skin incision was made on the incorrect side (left). Subsequent right wrist open reduction and internal fixation goes uneventfully. What is the next best course of action?

(OBQ08.233) A 25-year-old man sustains a Grade III-A open tibial shaft fracture secondary to a motorcycle accident. The patient is unconscious and has no family members who can be reached for consent. What is the most appropriate course of action?

(OBQ07.109) When a Workers' Compensation patient recovers after an injury to a point that further restoration of function is no longer anticipated, he or she is said to have reached which of the following?

(SAE07SM.68) A player on a professional football team sustains a knee injury and is diagnosed with an anterior cruciate ligament rupture. When employed as the team physician, your ethical obligation is to inform

(SAE07SM.52) A 21-year-old collegiate scholarship football player has an episode of transient quadriplegia. An MRI scan of the cervical spine reveals cord edema and severe congenital spinal stenosis. The athlete has aspirations of playing on a professional level and demands that he be allowed to play. The team physician should give what recommendation to the college?

(SAE07PE.1) A pediatric orthopaedic surgeon refers a child to a neurologist. The neurologist’s office requests the office records of the pediatric orthopaedic surgeon. To maintain Health Insurance Portability and Accountability Act (HIPAA) compliance, what must the surgeon obtain from the parent(s) prior to sending records?

(OBQ07.146) The operative report of a recent patient incorrectly documents the timing of peri-operative antibiotic administration. How should the medical record be legally altered?

(SBQ07PE.1) An orthopaedic surgeon is a team physician for a college football team. In which of the following scenarios is it appropriate to discuss a 19-year-old collegiate football player's lumbar spondylosis without additional consent from the player?

(OBQ07.61) A busy orthopaedic surgeon enters the operating suite to a prepped and draped patient who is scheduled for a right knee ACL reconstruction. During the diagnostic arthroscopy, the surgeon sees an intact ACL. The MRI is reviewed and found to be of the left knee. Wrong site surgery could have been likely avoided if which of following was done?

(OBQ07.32) Which of the following terms is defined as a loss of function resulting from an anatomic or physiologic derangement?

(OBQ07.267) Which of the following terms best describes failure to exercise the degree of diligence and care that a reasonable and prudent person would exercise under similar conditions?

(OBQ06.76) What function does computerized physician order entry have on medication monitoring?

(OBQ06.164) You are caring for a 50-year-old male who is 2 years status-post a work related pilon fracture. Since this is a workers compensation case, your patient is interested in settling his claim. When can his claim be legally settled?

(OBQ05.263) A 60 year-old male was brought into the operating room for total hip replacement. Before making the incision, what precautionary procedure must be performed by the entire staff to minimize surgical error?

(SBQ04PE.32) Prior to undergoing a total knee arthroplasty at an academic medical center a patient is told during informed consent by the attending surgeon that resident involvement in the case will be limited to retracting. During the case the attending is present up to trialing of the selected components. The surgeon leaves prior to cementing to start trialing components in another case while the chief resident remains alone in the room for the completion of the case. Which of the following is true regarding the ethics of this practice?