Dancing mishap

A 28 year-old professional dance teacher injured her left knee in a tango demonstration class. The initial diagnosis was of a transient posterior dislocation of the knee. The limb was placed into a hinged brace pending out patient follow-up. The patient saw an orthopaedic surgeon, an MDU member, who arranged an MRI scan. This revealed more extensive damage than anticipated, including an avulsion injury to the posterior cruciate ligament.

This correlated clinically with a positive posterior draw test. At subsequent arthroscopy, the posterior ligament was absent, and the orthopaedic surgeon recommended that the patient undergo a posterior cruciate ligament repair at a later date.

The patient was consented for a quadriceps tendon graft procedure, which was performed uneventfully under x-ray guidance. General anaesthesia was supplemented by a “3 in 1” nerve block, providing analgesia to those areas of the knee innervated by the femoral, lateral femoral cutaneous, and obturator nerves.

In the recovery room, the patient was hypertensive and complained of pain in the left ankle. The anaesthetist considered that the nerve block had worn off. The patient was given intravenous opiate which eventually provided relief. The surgeon reviewed the patient and noted the toes were pink but numb. The limb was monitored overnight by ward staff who noted the presence of pedal pulses, but that the foot remained numb. By morning the pain had intensified and the pedal pulse was no longer present. The calf was swollen and tight. No sensation or motor activity was present, and the patient complained of severe pain on passive flexion. Ward staff contacted the surgeon who returned to review the patient mid-morning, and diagnosed compartment syndrome.

He arranged that the patient return to theatre for urgent fasciotomies. These were carried out later in the afternoon. Shortly after reaching the recovery room, the patient became hypotensive and pale. She was returned to theatre and surgical exploration revealed damage to the popliteal artery and vein. This was repaired successfully. Over the next few weeks, the patient required several further operations. She exhibited a foot drop and nerve conduction studies demonstrated significant nerve damage. She was left with reduced mobility, relying on a stick to walk.

Two years after events, a claim was brought against the surgeon. The patient alleged that the surgeon had breached his duty of care by failing to recognise the post-operative compartment syndrome in a timely manner. With earlier fasciotomy, she argued, the nerve damage and subsequent disability would have been reduced considerably.

The MDU sought an expert orthopaedic opinion. Notably, there was no allegation that the original surgery was performed negligently, as vascular damage is a recognised complication. However, the expert was critical of the surgeon for not leaving adequate monitoring instructions for the ward in light of the patient’s numbness in the recovery room. Bearing this fact in mind, the expert highlighted that the surgeon had not returned earlier to review the patient the morning after surgery. The surgeon agreed with the expert’s views and consented for the MDU to settle the case.

The claimant sought a significant sum in compensation. A large proportion of this was for loss of earnings, alongside components for care, aids and equipment. Condition and prognosis evidence was obtained which confirmed the patient’s problems with mobility, but observed that she was still able to run her business and perform her duties as a dance teacher in part. After lengthy negotiation, the claim was settled for £600,000.

This page was correct at publication on 01/08/2012. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.