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The Journal of Bone and Joint Surgery 83:142 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Ethics in Practice

Inability to Obtain Formal Informed Consent in the Face of a Standard Surgical Indication

David M. Kahler, MD and Walt Davis, MD

David M. Kahler, MD
Department of Orthopaedic Surgery, University of Virginia Health System, Box 159, Charlottesville, VA 22908, E-mail address: dmk7y@virginia.edu.
Walt Davis, MD
Department of Physical, Medicine and Rehabilitation, University of Virginia Health System, 545 Ray C. Hunt Drive, Suite 240, Charlottesville, VA 22903-2981

A thirty-eight-year-old intoxicated man was admitted to the surgical trauma service following a single motor-vehicle accident. He had a severe closed head injury, bilateral pulmonary contusions, a fracture-dislocation of the right acetabulum, and an open injury of the right knee joint. The acetabular fracture pattern was an associated both-column fracture with the femoral head dislocated into a widely displaced posterior-column fracture line. The treating physicians agreed that it would be in the patient's best interest to take him to the operating room for emergent débridement and irrigation of his knee wound. At surgery, the patient also underwent attempted closed reduction of the acetabular fracture and placement of a skeletal traction pin. Radiographs obtained with the patient in traction showed reduction of the femoral head beneath a displaced superior dome fragment, but there remained a 12-mm gap in the posterior column, greater than 3 mm of step incongruity, and a large . . . [Full Text of this Article]


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