Defense Verdict in a Case of a Hamstring Tear with Avulsion
PRI obtained a defense verdict on behalf of an orthopedic surgeon, in a case of a right hamstring avulsion with alleged disability and development of complex regional pain syndrome.
The plaintiff was a 53-year-old female with type 2 diabetes and hypothyroidism who slipped and fell while walking. She was unable to stand following the fall, and was brought to the ED by ambulance. On exam, she was found to have tenderness along the entire right hamstring distribution with pain on extension of the right knee. The patient had x-rays and a CT scan performed in the ED, both of which were negative for fracture. The pelvic CT noted a hematoma at the right gluteal area. The patient was admitted to the hospital due to pain and inability to ambulate.
Our orthopedic surgeon was called to consult. Following his exam and review of the imaging studies, the orthopedic surgeon diagnosed a hamstring tear and recommended in-patient physical therapy followed by office follow-up, 1-2 weeks post-discharge. Specifically, the orthopedic consultant documented “No aggressive orthopedic intervention is warranted at this time.”
Three weeks later, the patient followed up with the orthopedic surgeon. She was using a cane and still complaining of pain. The patient was started on outpatient physical therapy and was followed monthly by the surgeon. Three months later, the patient was still in pain with right leg weakness and an MRI was ordered by the orthopedic surgeon. The findings were significant for an extensive tear of the right hamstring muscles and tendons with tendon avulsion from the right ischial tuberosity and hamstring muscle retraction. The patient elected to have a surgical intervention and a right hamstring repair with sciatic nerve neurolysis which was performed by our orthopedic surgeon. Intraoperatively, the surgeon encountered scar tissue encasing the sciatic nerve requiring meticulous neurolysis. Postoperatively, the patient had a poor recovery. She complained of restricted mobility and pain with hypersensitivity in the distribution of the sciatic nerve to the popliteal region. The patient subsequently came under the care of a pain management physician who diagnosed her with chronic regional pain syndrome.
The patient brought suit against our orthopedic surgeon alleging that he failed to repair her tendon in a timely fashion thereby causing damage to her sciatic nerve resulting in permanent pain and disability.
At trial, the plaintiff attorney tried to show that the plaintiff was unaware that she had a torn hamstring with ligament injury throughout her hospitalization and physical therapy. Had she known, it was suggested, she would have chosen to have surgery earlier. In defense of our orthopedic surgeon, defense counsel produced documents submitted by the plaintiff to her insurance company. In these documents, dated prior to the time the plaintiff states becoming aware of her diagnosis, the plaintiff had written into the insurance claim that she had a torn hamstring and tendon. In so doing, defense counsel was able to cast doubt on plaintiff’s allegation that our surgeon never informed her that she had a tear of her muscle and tendon. The defense was then able to further show to the jury that the orthopedic surgeon had in fact properly informed the patient of her condition from the outset as well as to describe the possible options available before arriving at the shared-decision not to have surgery.
Next, PRI obtained the testimony of expert physicians who testified that our orthopedic surgeon’s plan was well within the standard of care. Experts for the defense were able to explain to the jury that, due to the patient’s comorbidities, body habitus and lifestyle, non-operative treatment was wholly appropriate for this patient and essentially a more favorable approach than surgery. Through direct examination, lead defense counsel obtained testimony from PRI’s pain management expert stating that plaintiff’s residual complaints were likely attributable to the underlying injury and were not a product of complex regional pain syndrome. He further testified that the orthopedic surgeons plan was quite reasonable and had it been successful, would have prevented the surgery and the development of further pain and disability.
In the end, the jury returned a unanimous verdict in favor of our orthopedic surgeon, determining that our surgeon had not departed from good and accepted practice in not performing surgery within 4-6 weeks of the time of injury.