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1 November 2022 | Case Study | Article by Gill Edwards

Delay in treating leg injury results in amputation for young man


Motorcyclist injured in road traffic accident receives over £4 million in compensation for clinical negligence. In April 2015, Matthew, then aged 21, was involved in a road traffic accident when he lost control of his motorcycle and crashed. He sustained fractures to his right femur, tibia and fibula and after surgery he developed compartment syndrome in his right lower leg. There was a delay in diagnosing and treating this condition and the lower leg could not be saved. Matthew underwent a right below knee amputation in August 2015. As a result of the injury, Matthew was unable to take up a Sports Degree at University or to pursue a career as a teacher.

Matthew’s recovery and rehabilitation were not straightforward. He had problems with pain and swelling of the stump and pins and needles. He developed abscesses and his prosthetic sockets were uncomfortable. He also suffered from PTSD.

The Defendant admitted breach of duty and admitted that an amputation would have been avoided if appropriate treatment had been given, but causation remained in dispute in relation to the condition of the leg if the negligence had not occurred. The Defendant argued that, even if Matthew’s condition had been properly treated, his leg would have been so damaged that his loss of function and long term needs would have been similar.

Matthew was initially provided with NHS prosthetics, but once he had received an interim payment from the Defendant, he was able to seek help from a private provider, PACE Rehabilitation, and he had the opportunity to trial more sophisticated electronic prostheses which gave him more comfort and better function.

Judgment was entered in September 2019 on the basis that that there was a delay in diagnosing compartment syndrome, signs of which were present on the evening of 29th July 2015. The Defendant accepted liability to compensate the Claimant on the basis that, but for the Trust’s admitted breach of duty, intervention would on the balance of probabilities have salvaged his limb. However, the extent of Matthew’s injury but for the admitted negligence, his prognosis and quantum were still to be determined.

A large interim payment was made in 2019 which enabled Matthew to purchase a bungalow. The property was adapted to suit Matthew’s needs, and this facilitated his rehabilitation by enabling him to have further surgery to his residual limb, use a wheelchair to recover and to continue with prosthetic trials. Interim payments during the case totalled £1.08 million.

Attempts were made to settle the case prior to Trial but the Defendant’s highest Part 36 offer was £3.5million and this was rejected. The case went to a 5 day causation and quantum Trial in March 2022 where the Judge heard evidence from various witnesses including experts in Orthopaedic Trauma Surgery, Rehabilitation Medicine, care and prosthetics. The Judge, Mr. David Allan QC, sitting as a Deputy High Court Judge, was required to decide a number of key issues, including whether there would have been non or delayed union of the tibial fracture, the length of recovery time and the extent of ongoing pain and disability if the compartment syndrome had been diagnosed sooner.  He also had to decide whether Matthew now had a reasonable need for high activity prosthetics and a microprocessor ankle/foot prothesis and his long term care needs.

The Judge heard key evidence from the experts in Orthopaedic Surgery; Mr Britten, a trauma surgeon specialising in complex lower limb reconstruction, for the Claimant, and Mr Kenny for the Defendant. When considering the likely condition of Matthew’s leg if the compartment syndrome had been diagnosed sooner, the experts disagreed on the classification of the tibial fracture and the likelihood of it healing with good functional ability.

However, part way through Mr. Britten’s cross-examination, the Defendant conceded that Mr Britten was correct on the issue on non or delayed union of the tibial fracture and the Judge accepted the evidence of Mr Britten, whom he described as “a most impressive expert”.  A written Judgment was then given on the basis of the following:

As a result of the negligence, Matthew’s current position is as follows:

  • He has significant ongoing symptoms with his stump which are worse when he attempts to use a prosthesis for prolonged periods.  He does not have a normal gait.
  • For several weeks a year he will be unable to use a prosthesis because of the condition of his stump.
  • With ageing he will develop muscle atrophy in the right leg which will impede the wearing of a prosthesis.
  • He is fit to undertake sedentary work from home or at a place of work with facilities such as a wheelchair access and disabled parking.  By age 60 to 65 he will find it increasingly difficult to work full-time.
  • He has a 10 to 20% risk of requiring a myoplasty in the short to medium term.  In the longer term he will need such an operation by his late 50s or early 60s.
  • Due to the amputation he is likely to develop degenerative changes such that he has a 5 to 10% risk of (i) a left hip replacement by 55 to 60, (ii) a need for revision by 70 to 75, and (iii) a second revision by 82 to 87.  He also has a 5 to 10% risk of left knee replacement by 55 to 60 with similar risks of revision and a second revision.

If the negligence had not occurred, Matthew’s position would have been as follows:

  • He would largely have recovered from his injuries within about 12 months.
  • The tibial fracture was likely to have healed without delayed union and without the need for further operative treatment.
  • He would always have been self-caring and would have been capable of carrying out all save the heaviest of domestic tasks.
  • He would not have been capable of being a PE teacher and would have needed to avoid employment involving prolonged standing, walking or heavy lifting.
  • He would have been able to undertake domestic activities, where one can take a rest when required, in contrast to employment where such rests would not be acceptable.
  • He would have been able to work to normal retirement age.
  • He would not have been at increased risk of degenerative change.
  • He would have been capable of running short distances.
  • He would have been able to crouch or kneel with some mild discomfort on rising.
  • He would have been largely pain-free save that in cold/damp weather he might have had mild pain.

The Judge went on to consider Matthew’s loss of earnings, his care and equipment needs and the provision of prosthetics. Matthew was a young and active amputee who was about to become a father and he needed prosthetics for daily activities in addition to high energy activities. The Judge decided that a microprocessor-controlled ankle was reasonably required and he awarded increased care and equipment, including a wheelchair accessible vehicle, towards the end of Matthew’s life when his needs would increase.  Matthew was awarded a lump sum of £4,676,442 in compensation.

Gill Edwards, Partner in Clinical Negligence at Hugh James who acted for Matthew, along with Sophie Birch, Solicitor of Hugh James, and Darryl Allen KC said:

“The result in this case reinforces the need to have the right legal and expert team on your side with a thorough understanding of the evidence, taking into account every detail of the individual circumstances of each client when applying the facts to each case; and to resist attempts by Defendants to apply a broad brush to cases of a certain type. I am delighted that Matthew and his young family can move forward with their lives with financial security for the future.”

The full Judgment is available to view here.

Author bio

Gill Edwards has specialised solely in clinical negligence throughout her career. She has acted for Claimants who have been injured due to all aspects of clinical negligence involving GPs and hospital Trusts and she specialises in birth injury, brain injury, spinal cord injury and amputation claims.

Disclaimer: The information on the Hugh James website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. If you would like to ensure the commentary reflects current legislation, case law or best practice, please contact the blog author.

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