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Acute Rehabilitation is Necessary Care for Lower Extremity Crush Injuries

What can the injured do to get the best and most appropriate medical care? Dr. Greg Vigna, MD, JD

Sacramento, CA, 10/19/2015 /SubmitPressRelease123/

High-energy motor vehicle accidents produce crush injuries to the lower extremities that produce a variety of injuries capable of causing life long disability, post-traumatic arthritis, and catastrophic pain syndromes.  These injuries include tibia plateau fractures, fracture dislocations of the ankle and foot, nerve damage, and compartment syndromes that require prolonged wound care and skin grafting, prolonged immobilization, and acute pain management during recovery.  Because these accidents often produce injuries to both legs, prolonged periods of restrictions in weight-bearing are required to allow bone healing and more often than not referred to ‘skilled’ nursing homes because of cost consideration leading to complications of contractures, untreated pain syndromes, and delayed treatment of complications to the medical detriment of the injured.  As a Board Certified Physiatrist who has practiced at every level of care including Level 1 Trauma Centers,

‘Skilled’ Nursing Homes, Long-Term Acute Hospitals, and Acute Rehabilitation Hospitals restrictions in weight bearing should not be a barrier to receiving acute rehabilitation for those who suffer severe injuries to the lower extremity.

My reasons for this go to the complexity of injuries, the potential medical complications, and the coordination of care required.  The are a variety of specialist involved in these complex cases including orthopedic foot and ankle specialist, orthopedic trauma specialist, reconstructive plastic surgeons, vascular surgeons, anesthesia pain management, nursing wound care specialist, and physical and occupational therapist.  Patients admitted to a Acute Rehabilitation Hospital receive these services under the medical supervision of a specialist in Physical Medicine and Rehabilitation who oversees the entire management of the patient, coordinates care, and is responsible for identifying and treating complications throughout the injured person’s medical stay and into the future as they age with a disabling injury.

By timely identifying complications such as infections, problematic contractures, reflex sympathetic dystrophy, and associated undiagnosed injuries early intervention is possible decreasing the risk of future disability and optimizing functional outcomes.

Why are patients sent to nursing homes to heal instead of rehabilitation hospitals?  Simply cost.  Skilled nursing home Per Diem is generally one third of the cost of rehabilitation hospitals.  In addition, two decades of Medicare cuts and the continued rationing of care by the Centers of Medicare & Medicaid has made the criteria so difficult for the injured to get into rehabilitation hospitals that it has become ‘the standard of care’ to send those with catastrophic injures to the lower extremity to nursing homes instead of rehabilitation hospitals to the injured person’s medical detriment.

What can the injured do to get the best and most appropriate medical care?  Not much, unless you were injured because of the negligence of a ‘deep pocket’.  Early intervention by a life care planner during acute hospitalization who is hired by the injured person’s catastrophic injury attorney to identify the best options available regarding care, and timely intervening on behalf of the injured to ensure that the discharge option is most appropriate to meet the individual needs of the injured, rather than simply being delivered to the cheapest.

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Dr. Greg Vigna, MD, JD

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