Table Of ContentMEDICOLEGAL
REPORTING IN
ORTHOPAEDIC
TRAUMA
CommissioningEditor:MichaelHouston
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F O U R T H E D I T I O N
MEDICOLEGAL
REPORTING IN
ORTHOPAEDIC
TRAUMA
Michael A. Foy
BM, FRCS
Consultant Orthopaedic Surgeon
Great Western Hospital
Swindon, UK
Phillip S. Fagg
MBBS, FRCS
Consultant Orthopaedic Surgeon
Doncaster and Bassetlaw Hospital
Doncaster, South Yorkshire, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2010
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ISBN:978-0-443-06833-1
BritishLibraryCataloguinginPublicationData
Medicolegalreportinginorthopaedictrauma.–4thed.
1.Woundsandinjuries–GreatBritain.2.Fractures–
GreatBritain.3.Medicaljurisprudence–GreatBritain.
I.Foy,MichaelA.II.Fagg,PhillipS.
346.4’10323-dc22
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Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
ListofContributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Section 1 Medicolegal practice
1 The orthopaedic surgeon’s viewpoint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Martin F. Gargan
2 The legal viewpoint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
David Roberts Bertie Leigh
3 The orthopaedic surgeon in court . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Kate Hill
Section 2 Results following upper limb fractures
4 The shoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Phillip S. Fagg
5 The humerus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Phillip S. Fagg
6 The elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Phillip S. Fagg
7 The forearm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Phillip S. Fagg
8 The wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Phillip S. Fagg Carlos Heras-Palou
9 Hand injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Carlos Heras-Palou
Section 3 Results following lower limb fractures
10 The hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Michael A. Foy
11 The femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Aswinkumar Vasireddy Michael A. Foy
12 The knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
G. Philip Wilde
13 The tibia and fibula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Michael A. Foy
14 The ankle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Louise Nordin Michael A. Foy
15 The foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Roger M. Atkins
v
Contents
Section 4 Results following fractures of the axial skeleton
16 The pelvis and acetabulum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Martin D. Bircher Mark Rickman
17.1 The cervical spine: whiplash injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Gordon Bannister Rouin Amirfeyz
17.2 The cervical spine: fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
John Hutchinson
18 Assessment of patients with low back problems in the medicolegal setting . . . . . . . . . . 375
Michael A. Foy
19 Thoracic and lumbar spine fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Anthony J.B. Fogg Michael A. Foy
20 Traumatic spinal cord injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Anbananden Soopramanien
21 Head injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Chittoor. J. Rajaraman David A. Jellinek
Section 5 Miscellaneous topics
22 Soft tissue injuries, including burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
Andrew Hart Simon P.J. Kay
23 Peripheral nerve injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
Grey E.B. Giddins
24 The psychological effects of trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
Gordon J. Turnbull Roger N. Bloor
25 Complex regional pain syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
Roger M. Atkins
26 Arm pain and work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
Tim R.C. Davis
27 Radiology in medicolegal practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
David J. Wilson
28 Hand–arm vibration syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509
Christopher L. Welsh
29 Medicolegal aspects of cauda equina syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . 515
Nicholas V. Todd
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
vi
Preface
When we first discussed writing a book about medicolegal We are truly grateful to our contributors and their families
reporting over twenty years ago little did we realise that its for the valuable time they have given up in the preparation of
successwouldleadtoafourthedition.Wearealsoproudthat their chapters.
the third edition won the Minty prize at the Society of PhillipFaggisgratefultoEileenAustinforinvaluablesecre-
Authors and Royal Society of Medicine Book Award in 2002. tarial help and Jean Johnson for her tireless work as his
Over those twenty years, and more especially since the research assistant.
third edition, the profile of the medical expert in court has MichaelFoywouldliketoacknowledgeadviceandguidance
beenhighlyscrutinizedandthecaseofProfessorRoyMeadows providedbyMJPIvoryandDrMichaelAdamsintheprepara-
hashighlightedtheimportanceoftheaccuracyoftheevidence tionofchaptersonTheHip,TheTibiaandFibula,andAssess-
experts give and the importance of not straying into areas ment of Patients with Low Back Problems in the Medicolegal
outside one’s own expertise. Setting,respectively.
It is therefore important that this book is not regarded OurthanksalsogototheeditorialstaffofElsevierLtdwho
by newcomers to personal injury litigation as giving them a encouraged us to meet deadlines.
"licensetopractice".Itisimportantthattheyavailthemselves Last but not least we also wish to thank our wives, Judith
of the many courses that are now available. However, we and Denise, for their support during this project.
hope that, once suitably trained, this book will help in the Phillip S Fagg
preparation of the report and save a lot of unnecessary hours Michael A Foy
in researching the literature. 2010
vii
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List of Contributors
RouinAmirfeyzMD,MSc,FRCS(Trau&Orth) AndrewHartMBChBBSc(Hon),MRCS,AFRCS,MD(Hon),PhD,
SpecialistRegistrarinTraumaandOrthopaedics,Departmentof FRCS(Plast)
TraumaandOrthopaedics,BristolRoyalInfirmary,Bristol,UK ConsultantHandandPlasticSurgeon,CanniesburnPlasticSurgery
Unit,GlasgowRoyalInfirmary;HonorarySeniorResearchFellow,
TheUniversityofGlasgow;DeputyEditor,JournalofPlastic
RogerM.AtkinsMA,MB,BS,DM,FRCS
ReconstructiveandAestheticSurgery,Glasgow,UK
ProfessorofOrthopaedicSurgery,UniversityofBristol;Consultant
OrthopaedicSurgeon,DepartmentofOrthopaedicSurgery,Bristol
RoyalInfirmary,Bristol,UK CarlosHeras-PalouFRCS(Trau&Orth)
ConsultantinHandandWristSurgery,PulvertaftHandCentre,
RoyalDerbyHospital,Derby,UK
GordonBannisterMD,MCh(Orth),FRCS,FRCS(Ed),FRCS(EdOrth)
ConsultantOrthopaedicSurgeon,NorthBristolNHSTrust,Professor
ofOrthopaedicSurgeryUniversityofBristol,Bristol,UK KateHillBA(Hon),CPE,LSF
Solicitor,PrivatePractice,London,UK
MartinD.BircherFRCS
ConsultantOrthopaedicSurgeon,St.George’sHospital, JohnHutchinsonMBBCh,BaO,FRCS,MMedSci,FRCS(Orth)
London,UK ConsultantOrthopaedicSpinalSurgeon
FrenchayHospital,Bristol,UK
RogerN.BloorMD,MPsyMed,FRCPsych
ConsultantPsychiatristandTeachingFellow,KeeleUniversity DavidA.JellinekBSc(Hon),MB,BChir,MD,FRCS(SN)
MedicalSchool,Stoke-on-Trent,UK HonorarySeniorLecturerinNeurosurgery,Department
ofNeurosurgery,UniversityofSheffield,Sheffield,UK
TimR.C.DavisMB,ChB,BSc,FRCS,MCh
SpecialProfessorinTraumaandOrthopaedicSurgeryand SimonP.J.KayBA,FRCSE(Hon),FRCS(Plast)
ConsultantHandSurgeon,UniversityHospitalQueensMedical ConsultantHandandPlasticSurgeon,DepartmentofPlastic,Hand
Centre,Nottingham,UK andReconstructiveSurgery,President;TheBritishAssociationof
Plastic,ReconstructiveandAestheticSurgery,ProfessorofHand
Surgery,UniversityofLeeds,Leeds,UK
PhillipS.FaggMBBS,FRCS
ConsultantOrthopaedicSurgeon,DoncasterandBassetlaw
HospitalDoncaster,UK BertieLeighHonFRCPCH,FRCOGadeundem
SeniorPartner,Hempsons,ChairNCEPOD,London,UK
AnthonyJ.B.FoggBSc,MBBS,FRCS
ConsultantOrthopaedicSurgeon,GreatWesternHospital, LouiseNordinMRCS
Swindon,UK OrthopaedicRegistrar,OrthopaedicDepartment,Southampton
GeneralHospital,Southampton,UK
MichaelA.FoyBM,FRCS
ConsultantOrthopaedicSurgeon,GreatWesternHospital, ChittoorJ.RajaramanMBBS,MRCS(Gensurg),FRCS(Neurosurg)
Swindon,UK ConsultantNeurosurgeon,DepartmentofNeurosurgery,
HullandEastYorkshireHospitalNHSTrust,Hull,UK
MartinF.GarganMA(Hon)Oxon,FRCS(Tr+Orth)
ConsultantOrthopaedicSurgeon,BristolRoyalInfirmary, MarkRickmanMDFRCS(Tr&Orth)
Bristol,UK ConsultantOrthopaedicandTraumaSurgeon,Departmentof
Orthopaedics,St.GeorgesHospital,London,UK
GreyE.B.GiddinsMBBCh,FRCS(Orth),DBA,EDHS
ConsultantOrthopaedicandHandSurgeon,RoyalUnitedHospital, DavidRobertsLLB,PhD
Bath,UK Partner,Hempsons,Harrogate,UK
ix
