The case of a nine-year-old girl in Kerala who lost her hand after alleged lapses in hospital care has once again spotlighted a troubling issue: many amputations in India are not inevitable, but occur because fractures and wounds are not treated promptly or adequately. Doctors explain how neglect, systemic gaps and lack of awareness create conditions where preventable infections escalate to limb loss.
When the “golden hour” is lost
The earliest hours after a fracture or traumatic wound determine whether a patient heals or risks losing a limb. Navaladi Shankar, senior consultant, orthopaedics at Apollo Hospitals, Chennai, stresses that untreated fractures create the perfect environment for infection.
“The haematoma at the fracture site forms a good culture medium for bacteria. If debridement in open wounds is not thorough, bacteria stay and multiply rapidly, leading to osteomyelitis (bone infection), necrotising fasciitis, (a severe, rapidly spreading infection of the soft tissue and fascia) and even limb amputation,” he explains. Once bacteria form biofilms, they become resistant to antibiotics, leaving tissues increasingly difficult to salvage.
Panthala Rajakumaran, senior consultant orthopaedic surgeon at VS Hospitals, Chennai, calls this window the “golden hour.” “An open fracture is as much an emergency as a heart attack. Delay is a recipe for infection and its cascading effects. Once bone infection sets in, it is extremely difficult to reverse. I have seen patients who could have healed perfectly, lose their limbs just because first care was late or incomplete,” he says.
Oft-missed signs
Early detection of infection is critical, yet doctors say that families and even hospitals often miss red flags.
According to Dr. Shankar, signs such as persistent swelling, redness, warmth, low-grade fever, or delayed wound healing are often dismissed as a normal part of recovery. Systemic signs such as fatigue, confusion or lymph node tenderness may also indicate early sepsis.
Mohit Madan, director & unit head, Orthopaedics & Joint Replacement, Dharamshila Narayana Superspecilaity Hospital, Delhi notes that indicators such as pain worsening at the injury site, swelling, warmth, or purulent discharge can be mistaken for post-surgical inflammation. “Rapid identification at the earliest is essential. Left untreated, these symptoms allow infections to progress,” he warns.
Dr. Rajakumaran adds that families frequently ignore persistent pain and fever. “Even some small centres do not pick it up early. The earlier we intervene, the easier it is to save tissue and function,” he says.
R. Krishnamoorthy, senior consultant plastic surgeon at SIMS Hospital, Chennai, uses classical medical descriptors: dolor, calor, rubor, tumour, and functio laesa — pain, heat, redness, swelling, and loss of function. “These are early signs: delay leads to pus, abscesses, or spreading gangrene,” he says.
Barriers to care
Many of these preventable infections begin not with deliberate neglect but with systemic shortages.
Dr. Madan points out that rural hospitals face chronic deficits: “There are shortages of trained surgeons and nursing staff. Infection prevention is inconsistent due to lack of sterilised equipment or oversight. Diagnostics may be absent or delayed, leaving doctors dependent on broad-spectrum antibiotics instead of targeted therapy.”
Jegan Mohan, consultant in internal medicine at SRM Global Hospitals, Chennai, highlights that weak triage, poor referral systems and delayed lab reports worsen outcomes. “Infection control lapses from inadequate hand hygiene to crowded wards — all increase risk. When established treatment protocols are ignored, it is negligence,” he says.
Dr. Rajakumaran adds that shortages of trained personnel, poor sterilisation of dressings, and lack of routine follow-up are common in district hospitals. “It is not always deliberate neglect; it is often weak systems. But the patient suffers just the same,” he says.
Dr. Krishnamoorthy points to inadequate infrastructure: “Many secondary hospitals lack emergency theatres, trained staff, or sterilisation facilities. First treatment is delayed, follow-up systems are absent, and infection monitoring is weak. These gaps directly result in poor healing and long-term disability.”
Building systemic reforms
Experts stress that reforms must go beyond individual hospitals. Dr. Madan stresses the need for infection control committees, regular audits, and standardised protocols across hospitals. “Linking hospital performance to infection indicators and independent audits can improve adherence,” he says.
Doctors also emphasis the importance of sentinel event reporting and root-cause analysis of unnecessary amputations. “Oversight must include measurable quality indicators such as time to debridement and wound infection rates. Accountability should focus on fixing problems, not just assigning blame,” he says.
Dr. Rajakumaran adds that small hospitals too, must have proper reporting. “If infection rates rise, it must trigger action. Assigning clear responsibility prevents tragedies,” he says.
Dr. Krishnamoorthy stresses the need for systemic investment: “Upgrading secondary hospitals, training doctors and nurses, and setting standard trauma and burns protocols is essential. A proper registry of cases and regular audits will identify weak areas and improve accountability.”
Role of community and patient education
Beyond hospitals, community awareness can play a decisive role in preventing infections from worsening.
Experts points to the importance of first aid, patient education, and follow-up: “Families must know to seek prompt care for fractures and wounds, and recognise infection warning signs. Community health workers can support follow-up and detect secondary infections early, “ Dr. Shankar says.
Dr. Jegan Mohan adds that clear discharge instructions, accessible wound clinics, and community outreach on injury prevention are needed. “Every hour of uncontrolled infection increases the chance of limb loss. Awareness and timely referral can make the difference,” he says.
Dr. Rajakumaran highlights that patients with diabetes and the elderly are especially vulnerable: “Wounds are never minor for them. PHCs can run simple wound-care clinics and educate families. Follow-up saves limbs.”
Dr. Krishnamoorthy calls for public health campaigns and referral systems. “Primary physicians must be trained to give correct first aid and refer early. Health education in schools and industries will also help. This is not a one-time effort but a continuous movement requiring strong coordination,” he says.
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