Orthopedic Malpractice

Brien Roche

Orthopedists are frequent players in personal injury claims.

Orthopedic Malpractice-Bone or Muscle Injuries

Orthopedic surgery or the general field of orthopedics deals with injuries to the bony system and to the muscles.
In any serious muscle or bone injury an orthopedic surgeon should be involved.  That orthopedic surgeon will then oversee the overall care. She will prescribe physical therapy or anesthetic injections for pain control as needed. She may make referrals to other doctors such as neurologists or physical medicine doctors. These doctors are able to provide more specialized treatment for certain injuries. Call, or contact us for a free consult.

Orthopedic Malpractice-Spine Surgery

The disc that is between the bony elements of the spine has what is called an annulus on the outer rim. It basically covers the circumference of the disc. That tissue has nerve fibers that can cause pain if it is damaged. Think of the annulus as being the bark on a tree. Sometimes the chemicals from the nucleus pulposus in the center of the disc can irritate the nerves in the annulus causing pain. This can result in symptoms even though there is no bulging disc.

The foramina are an important part of the spinal structure. They are the places where the nerves exit the spinal cord.

The neck is also called the cervical spine. Neck surgery is complex to say the least.  The most dramatic neck surgery comes in the form of what is called anterior cervical dissection and fusion. Both orthopedic and neurosurgical doctors may be involved in this surgery

Disc Removal or Fusion

This type of surgery is designed to relieve the pain, numbness, tingling and weakness that may be caused by nerve pressure.  That nerve pressure can be a result simply of the aging process. In addition it may be caused by a disc rupture or weakness of the spine.  The overall purpose of the surgery is to remove that pressure on the nerve. This involves a process known as decompression and fusing. The bones that make up the spinal column may be given more support through a series of plates and screws.  Once the spine is made more stable then any abnormal motion of the spine is stopped. If a disc has ruptured then the ruptured part of the disc is removed. If a fusion is also being done then two or more levels of the spine are joined through the placement of material where the disc material had been.

The surgery is referred to as anterior because the cut is made in the front of the neck. The doctor then divides the tissue in order to get to the spinal column. This is where the surgery takes place.

Fusion

A spinal fusion means that those parts of the spine are fused. However such a fusion puts additional stress on the parts of the vertebrae above and below the fusion. An alternative to fusion is the placement of an artificial disc. This allows motion between the vertebrae. A fusion does not. In addition it may prevent adjacent level degeneration.

Thoracic disc herniation is fairly rare. It can however be devastating because of the spinal compression that occurs in the thoracic area. If there is such compression, there may be a need for immediate surgery.

A frequent form of imaging that is used in dealing with the spine is the use of gadolinium with MRI imaging. This chemical can have some long-term brain consequences due to the body retaining it. It should definitely be used with caution in patients with renal problems or other patients who are somehow medically compromised.

See also the blogpost on this site dealing with spinal cord injuries.

Orthopedics: Impairment and Disability Rating

Impairment ratings within a personal injury lawsuit can be important.  See the blog on this site dealing with impairment ratings. They are different than disability ratings. In most cases the orthopedic surgeon is the one best able to provide what is referred to as a permanent partial rating.  This rating is based upon guidelines published by the American Medical Association. It puts into numerical form the extent to which a person is not able to function due to an injury to a body part. That rating will be applied to the injured body part. In addition it may be applied to the whole body.

Orthopedics: Ratings Are Important

If you are a veteran and making a claim against the Veteran’s Administration, then a disability rating is important. That rating fixes the amount of money you may receive for the rest of your life. If you are a workers’ compensation claimant and have suffered the loss of a limb or the loss of use of a body part, a rating will fix the money you receive for a scheduled loss.  For instance, if you have lost a right hand through an amputation then you would have a 100% impairment of that right hand.  If you have lost the use of the right hand then a doctor must ascribe a number to that loss of use. This then becomes the rating.  How much money you receive as to the loss of use of that hand then is a function of what that rating is.
In any event, that rating adds a dimension to the case that can increase its value. Call, or contact us for a free consult.

Orthopedic Malpractice-Muscle Injury

Muscle injury is a much-overlooked condition in the orthopedic field. Even though an orthopedic doctor focuses on muscle and bone injuries, they tend to ignore the muscle component. The muscle part of the injury is referred to as myofascial pain.  Myo is a reference to muscles. Fascia is the tissue that holds muscles in place. Myofascial pain syndrome is a condition caused by muscle fibers that contract and then do not release. That contraction causes knots within the muscle. These knots are called trigger points.

Trigger Points

These knots of muscle produce pain. These pain signals travel to the spinal cord. So-called “referred pain” occurs when pain signals from the muscles register in the nervous system as if they came from somewhere else. These trigger points can cause problems such as chronic back pain, headaches, pelvic pain. Trigger points can form anywhere on the body. They may be due to injury. Trigger points can be caused by bracing your body in advance of an impact. They can also be caused by overuse or poor posture.

Dry Needling

A popular treatment that has arisen to deal with trigger points is what is called “dry needling”. Dry needling is like acupuncture. It involves the placement of tiny needles into the skin to cause a twitch response in the heart of the trigger point.  That tends to release the trigger point. Unlike acupuncture, the dry needling focuses directly on the trigger points. It does not focus on the so-called “energy fields” that may be related to pain.

In addition to the dry needling, patients are encouraged to press the trigger point area against a hard surface. This can be done with such things as tennis balls. Other objects too can be used to press on the trigger point to relieve the knot.

This type of muscle injury and the resulting referred pain is tough to diagnose in many cases. It requires the doctor to follow the thread that may lead back to the trigger point which is the source of the pain.

Orthopedic Malpractice-Joint Replacements

Joint replacements are becoming more and more popular. With the population aging and the baby boomers living longer than expected joint replacements are increasing.   Most doctors who now perform either hip, shoulder or knee replacements are able to do these through less invasive surgery.

Hips

In regards to hip replacements, the direct anterior approach utilizes a cut in the front of the hip allowing muscles to be spread at natural openings in order to gain access to the joint.  This reduces the amount of muscle tissue that needs to be cut through.  In addition, hip resurfacing surgery can be done with patients who have strong bones. It involves the placement of a metal cap around the ball joint where the cartilage has worn down.

It is not uncommon that with hip replacement, there is a leg length discrepancy. If the discrepancy is more than 6 mm, that is potentially a basis for a medical malpractice claim.

In regards to knee replacements, computer navigation can be used to set the replaced parts and to stylize the fit to each patient. This method gives the doctor a better view of the site and allows him to reduce the cut that is needed.

For my comments on the necessity of these surgeries see the pages on this site. Call, or contact us for a free consult.

Orthopedic Malpractice-Lower Extremity Surgery

This surgery is generally a treatment of last resort for ankle arthritis.
Ankle arthritis is a form of what is called osteoarthritis.  It consists of the breakdown of cartilage between the bones. This may be due to damage or the aging process.  The bones physically come into contact with each other during movement. This produces pain.  The body responds to that pain either through inflammation or swelling. In cases where there is a lack of tissue where some should exist then there may be abnormal bone growth. These are called bone spurs.
Many of those people who experience ankle arthritis are those who have had previous injuries or fractures to that joint.
The first line of treatment for ankle arthritis is over-the-counter pain medicine and braces.  The braces limit motion and make the joint more stable.  Also physical therapy can help in the sense that it may strengthen the tendons and ligaments in the joint area.  In addition shoe orthotics help control the movement of the joint.  Likewise cortisone injections may relieve the swelling.  Another form of injections that are now being used are platelet or bone marrow injections. These are taken from the hip and injected into the ankle joint in order to promote growth of cartilage between the bones.

Orthopedic Malpractice-Fusion or Replacement

In terms of surgical options, there are two:  ankle fusion and total ankle replacement.

With ankle fusion the doctor glues the joint together. The joint no longer moves up and down.  That impacts your ability to walk. This can cause other joint problems.

With a total ankle replacement the damaged joint is actually removed and replaced with an artificial ankle. This then allows nearly normal movement.

However ankle replacement is not available for anyone with an active infection or damaged skin around the ankle or a missing bone in that area.

Orthopedic Malpractice: Total Ankle Replacement

Candidates for an ankle replacement typically are people with:

• advanced ankle arthritis,
• complex fractures with sequelae,
• congenital ankle deformities,
• hemophilic arthropathy,
• rheumatoid arthritis

Dr. Paul Cooper of Georgetown University is one of the leaders in this field.  He uses a replacement ankle that has been vetted by the FDA.  It is made in three pieces that move independently.  It gives patients better range of motion.  Also if one part of the ankle wears out then that part can be replaced.  The whole ankle does not need to be replaced.  Replacement joints usually last 10 to 15 years.

With this surgery the patient is walking in a boot within two weeks.  Within six to eight weeks the patient is in therapy.  In a year they are typically back 100%.

Compartment Syndrome

The lower leg is divided into four compartments. If fluid enters one compartment as a result of trauma and compresses adjoining muscles and tissues, that can potentially cause the death of that muscle and tissue. This is why with many significant lower extremity injuries, a trauma surgeon must be involved. The trauma surgeon can deal with compartment syndrome.

Safe Lifting and Avoiding Orthopedic Injuries

Any one of us can be called upon at various times to lift heavy objects.  Safe lifting is important. You should know the proper way to lift a heavy object.

Lifting With Your Legs

Many people attempt to lift objects essentially with their back.  Your lifting thrust should come rather from your legs and your buttocks, not from your back.  In order to do that you need to bend at the knee in order to get down to where the object is that you are intending to lift. You then rely upon your legs and your buttocks to pick the object straight up.

Having a firm grip on the object is important.  Once you have raised the object up it should be maintained basically at the level between your waist and your shoulders in the front of the body.

Safe lifting technique can prevent lower back injury. Yet it will allow you to complete the task either at work or home and enjoy the rest of the day. In contrast you may be spending the day in the emergency room or in the office of an orthopedic surgeon.

Shoulder Injuries

A common shoulder problem is what is called “frozen shoulder”. This occurs where the capsule contracts or shrinks. This is something that may be dealt with surgically.

Orthopedic Malpractice-Contact Us

Call, or contact us for a free consult. For more information on orthopedics see the pages on Wikipedia and the other pages on this site.