Sutured nerve

A female patient in her 20s was referred to a consultant orthopaedic surgeon, a member of the MDU, for investigation of a right knee injury. She was a keen squash player and hiker and had experienced a ten-day period of locking of the knee, causing some discomfort and pain.

The orthopaedic surgeon suspected a tear of the lateral meniscus, although an MRI scan was inconclusive. He suggested they adopt a 'wait and see' approach, but several months later, the patient returned with a recurrence of the same complaint. The surgeon felt that the patient’s history suggested a tear may have been missed on the original MRI scan.

Having discussed the pros and cons of the surgery and after having obtained consent from the patient, he carried out an examination under anaesthetic and arthroscopy of the patient's right knee.

At operation, the orthopaedic surgeon found a peripheral horn tear within the posterior margin of the lateral meniscus. He proceeded to repair this by using an 'inside out' technique, using long needles to pass loop sutures through the meniscus. He later acknowledged that, in hindsight, some of the soft tissue had pulled up when he tied the inferior suture.

In recovery, the patient complained of numbness on the dorsum of her foot and that she could not fully extend her toes. With no improvement several hours later, the surgeon decided to reopen the incision. He found that the inferior suture appeared to be tethering the common peroneal nerve up against the lateral head of gastrocnemius. The surgeon released the suture and noted that other than a small contusion there was no obvious damage to the nerve.

The patient was discharged using a foot drop splint. The surgeon explained that the nerve would not be permanently damaged and that the patient's disability would recover with time and physiotherapy. He advised the patient that in due course she would be able to resume sporting activities as before.

Eighteen months later, the surgeon received a letter of claim alleging that he had failed to advise the patient of the possibility of damage to the common peroneal nerve during this procedure. In addition, it was alleged that he had been negligent in tying a suture round the common peroneal nerve during the arthroscopy and that as a result the patient suffered temporary paralysis in her right leg. The claimant also alleged that she continued to experience pain on walking or other weight-bearing exercise.

MDU response

 

The surgeon passed the letter of claim to the MDU, who dealt with the matter on his behalf. He acknowledged that he had not mentioned the possibility of damage to the common peroneal nerve during the consenting process and, in fact, he had not experienced this rare complication previously. He had acted with great care during surgery but given the damage and extensive recovery period the claimant suffered, he believed that on balance the patient should be compensated. The MDU claims handler agreed and made an offer of £12,500 in settlement of the claimant's damages and legal costs. This was accepted by the claimant.



This page was correct at publication on 06/12/2010. 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.