Neuerburg C, Heberer K, Heberer J
Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Osteologisches Schwerpunktzentrum (DVO), Klinikum der Ludwig-Maximilians-Universität München, Campus Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland.
Rechtsanwaltskanzlei Dr. Heberer & Kollegen, Paul-Hösch-Straße 25a, 81243, München, Deutschland.
Unfallchirurg. 2015 Nov;118(11):938-43. doi: 10.1007/s00113-015-0072-1.
Through a more consistent diagnostics and treatment of osteoporosis, subsequent fractures and associated complications could be reduced in aged patients. Whereas anticoagulants are now standard in the treatment of fractures of the lower extremities to prevent thromboembolic complications in orthopedic surgery and an omission of anticoagulation can be regarded as medical malpractice, the management of osteoporosis following such fractures is very frequently disregarded. Although guidelines for osteoporosis, such as those from the governing body on osteology (Dachverband Osteologie, DVO) from 2014 are not legally binding as such, the breach of this standard of care can constitute a breach of medical obligation by the physician. The omission of osteoporosis diagnostics and initiation of treatment despite appropriate findings after fractures in aged patients, could represent a diagnostic assessment error and severe malpractice in the legal sense. In this case, evidence of a serious malpractice could be associated with civil, criminal and professional claims which could be linked with relevant legal consequences. Regardless of the legal consequences for omission of osteoporosis management following multiple fractures in aged patients, the management of osteoporosis should be an integral component in the treatment of these patients in the future.
通过对骨质疏松症进行更一致的诊断和治疗，可以减少老年患者随后发生的骨折及相关并发症。虽然抗凝剂目前是治疗下肢骨折的标准用药，以预防骨科手术中的血栓栓塞并发症，且不进行抗凝治疗可被视为医疗事故，但此类骨折后骨质疏松症的管理却常常被忽视。尽管骨质疏松症指南，如2014年骨科学 governing body（德国骨科学会，DVO）发布的指南本身并无法律约束力，但违反这一护理标准可能构成医生违反医疗义务。老年患者骨折后尽管有适当的检查结果却未进行骨质疏松症诊断及开始治疗，在法律意义上可能代表诊断评估错误和严重的医疗事故。在这种情况下，严重医疗事故的证据可能会引发民事、刑事和职业索赔，并可能带来相关法律后果。无论老年患者多次骨折后未进行骨质疏松症管理会带来何种法律后果，骨质疏松症的管理在未来都应成为这些患者治疗的一个组成部分。
