0
Ethics in Practice   |    
The Human FormAccepting the Prioritization of Patient Values
Michael Betsy, MD1; James D. Capozzi, MD2; Rosamond Rhodes, PhD3
1 Department of Orthopaedics, Mount Sinai Medical Center, 5 East 98th Street, New York, NY 10029
2 Departments of Orthopaedics, Mount Sinai Medical Center, 1065 Park Avenue, New York, NY 10128. E-mail address for J.D. Capozzi: capoz5@aol.com
3 Department of Bioethics, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029-6574
View Disclosures and Other Information
The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jul 01;87(7):1653-1655. doi: 10.2106/JBJS.D.03005eth
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

A seventeen-year-old boy who had had a subtotal femoral reconstruction because of an osteosarcoma in the left femur, and a subsequent revision for hardware failure, was again having severe pain secondary to failure of the endoprosthesis. The patient's original orthopaedic oncologist, who had performed both previous operations, recommended that the patient have an above-the-knee amputation. The patient and his parents inquired about the Van Nes rotationplasty. They were told directly that it was an antiquated procedure that was not done anymore. The prosthetist with whom they were working gave them the name of an orthopaedic oncologist who could perform the Van Nes procedure. They traveled 850 miles for a consultation, and the patient underwent the procedure.

Several months after the operation, the patient walked with a slight limp and looked like a perfectly normal teenager in a pair of jeans. On examination, he had a well-fitted below-the-knee prosthesis attached to his foot, which was in nearly 160° of what was essentially plantar flexion, perfectly matching the attitude of a knee as it couples to a below-the-knee prosthesis. The boy and his parents, who had decided months earlier to opt for an uncommonly performed procedure that would give him a chance at a "normal" appearing and functioning limb, deemed the surgery a complete success with an "excellent" outcome.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    04/02/2014
    WV - Charleston Area Medical Center
    06/29/2012
    PA - Thomas Jefferson University
    12/31/2013
    SC - Department of Orthopaedic Surgery Medical Univerity of South Carlonina