595
“Tf???” (thelemmy.club)
submitted 6 days ago by to c/science_memes@mander.xyz
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cross-posted from: https://thelemmy.club/post/54296827

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[–] 1 point 6 days ago (4 children)

If it was that damaged and you were already doing a tibial nail, there wouldn’t really be a reason not to do a fibular nail at the same time.

Yeah... supply issue maybe? Or patient opted out due to cost?

/shrug

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  • [–] 3 points 6 days ago (3 children)

    Supply issues aren't really an issue, orthopedic operations like this aren't exactly emergent care. If you have time to procure a tibial nail there isn't a reason you wouldn't be able to get a fibular nail at the same time.

    As far as cost, the same logic applies. When an orthopedist is coming up with a treatment plan you submit the treatment plan that would best lead to the overall best outcome for the patient, you don't really formulate based on the most economic outcome.

    The insurance company isn't going to deny a fibular nail, but approve a tibial one. If they are going to go out of pocket, the cost of the fibular nail would be negligible when compared to the overall cost of the operation. The most expensive aspect of an orthopedic moderation is the operating room and the anesthesia, not the additional hardware or operating time.

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  • [–] 1 point 6 days ago* (2 children)

    Just spitballing. Consent issue maybe? Like it only covered tibia, and the staff didn't notice until the patient was under / couldn't get a hold of family to have it added?

    How quickly can it absorb?

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  • [–] 2 points 6 days ago (1 child)

    That's not really how consent works, at least not in the US. You typically give consent for the operation, not for every individual procedure that's done in the operation. A lot of the times you don't really know what's going to be needed to be done until you have the patient opened up, so the provider has a lot of leeway to operate as they see fit.

    How quickly can it absorb?

    Depends on the individual and what bone we are talking about. Though that's quite a lot of bone to dissipate, so my guess would be that it's a fairly old injury.

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  • [–] 1 point 5 days ago

    From what I've seen in the US, it varies a lot from one facility to another. For surgery, most of what I've seen the consents address the expected operation "and all other indicated procedures" that give the surgeon the discretion to add something on intraoperatively if it's justified. That said, the facility I'm at now decidedly does NOT do that. They can add an operation on if it's an emergency, but something like a fibular nail would require specific consent. ...which they should have ahead of time, cuz imaging would make the need for one pretty obvious, but dumb shit happens and things get missed... So fast forward to the operation, patient is under, skin is cut, and circulator points out "uh, hey we only have consent for tibia..." If they have a family member available who can make decisions on the patient's behalf, that person could give consent, but if not they'd probably just skip it and schedule it as a later surgery.

    ...shit can get goofy.

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