Our expert witnesses in trauma & orthopaedics specialise in the management of individuals who have suffered injury or have bone and joint dysfunction. They are experts in managing patients in the acute setting, including those who have sustained major trauma to their pelvis and limbs, and in the aftermath of injury, including sports injuries and contractures.
Our experts in trauma & orthopaedics have a profound knowledge of managing degenerative joint conditions, with specialist interests in hip, shoulder, and knee surgery. Further, their extensive experience in the operating theatre means they can review operation notes and assess the practical nature of the surgical procedures performed, for example, total hip replacement, rotator cuff repair, meniscectomy.
With a strong understanding of appropriate standards of care and NICE Guidelines, in addition to a thorough knowledge of treatment pathways, our expert witnesses in trauma & orthopaedics can advise on causation, breach of duty, current condition, and prognosis in individuals who have sustained trauma or bone and joint dysfunction.
What is Orthopaedics?
The human body has 300 bones at birth, which gradually fuse, to leave 206 bones in the human adult body. The bones are held together at joints by ligaments, forming our skeleton, and have several primary functions:
- Protection – Bones, such as the skull and ribs, protect organs and soft tissues from external trauma.
- Blood production – Within bones is bone marrow, which is responsible for producing new blood cells.
- Mineral storage – Calcium, phosphate, and potassium are stored within the bone and are released into the blood stream when needed for physiological processes.
- Support and movement – The skeleton supports the weight of the soft tissue and organs and provides a lever for tendons and ligaments to attach to.
The joints in our body contain cartilage that functions as a shock-absorber and provides a smooth articulate surface, minimising friction between the ends of the bones. This cartilage can become damaged either over time or through trauma. When the cartilage degrades, there is an inflammatory response which results in the release of enzymes which cause further damage to the joint, bone remodelling, and the development of bone cysts. The space within the joint gradually reduces over time until the cartilage and joint space is completely lost, and the two bones rub against each other. This is known as osteoarthritis and most commonly affects the knees, hips, and spine. Individuals may undergo joint replacement surgery to manage these conditions.
A broken bone can be described as a pathological fracture or a traumatic fracture. Pathological fractures are when no force has caused the bone to break; an underlying disease has made the bone weak and susceptible to breaking through normal movement of the body. Osteoporosis (low density bone) and cancer are common causes of a pathological fractures.
Traumatic fractures can be further categorised:
- Stress fractures – These are very small cracks in the bone that have developed due to overuse. For example, stress fractures of the metatarsal bones (foot bones) in long distance runners
- Undisplaced fractures – When the bone has broken into two however there has been minimal movement.
- Displaced – when the bone has broken into two and become misaligned.
- Comminuted fractures – when the bone has shattered into multiple pieces.
- Avulsion fracture – when a tendon pulls away a piece of bone.
- Open fracture – also known as a compound fracture, this is when the broken bone breaks through the surface of the skin. These are particularly susceptible to infection and disease such as osteomyelitis.
There are various methods of treating fractured bones, ranging from conservative rest, pain relief, and anti-inflammatories, to surgical repair and reduction with intermedullary rods and external fixation devices.
Complications of Fractures
Deep vein thrombosis and thromboembolism are common complications from fractures where there has been damage to blood vessels. Further, if there has been bleeding into the muscle, the individual may develop compartment syndrome; blood accumulates within the muscle, which is surrounded by a fibrous layer of fascia, causing increased pressure that restricts blood flow to the area, and leads to nerve and muscle damage. This requires an emergency fasciotomy, whereby the muscle is cut open to relieve the pressure.
Fractures and joint dislocations (subluxation) can result in damage to the surrounding tissues, such as nerves, blood vessels, and muscles. Fractures of the femur (thigh bone) past the intertrochanteric line, damage the bloody supply to the head of femur (hip joint) and lead to avascular necrosis (death of bone due to no/reduced blood supply); these fractures require a hip replacement. Shoulder dislocations can result in compression of the axillary nerve and require reduction in a timely manner.
Non-Traumatic Bone Pathology
Whilst trauma is a common cause of bony injuries, there any many bone conditions and diseases that result from congenital conditions and other medical conditions. Osteomalacia is a condition where the bones are very soft as a result of a lack of vitamin D and can lead to Rickets. Osteoporosis is when the bones have low bone density and is commonly associated with menopausal individuals, calcium deficiency, and an inactive lifestyle. Conversely, osteopetrosis is where bones have markedly increased bone density; however, this bone is disorganised, brittle, and susceptible to fractures.