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Teenage lower leg amputee becomes youngest in UK to have specialist osseointegration surgery

We act for the youngest patient in the UK who has had osseointegration with elective amputation following a car collision as a pedestrian.

Scarlett*, who is now 17 years old, lost her right lower leg below the knee when a car, being driven by a reckless young man, struck another car and then mounted the pavement. The car hit Scarlett and caused her shin bone to fracture at the ankle and below the knee and be ejected at impact through her skin. Scarlett was just 10 years old at the time.

The rest of her shin, foot and ankle were removed at hospital and Scarlett was left with a very poor stump and a damaged knee joint, which was not wholly anatomical, and which had been saved using some of the amputated ankle bone. Her residual stump was very painful and scarred and would not support a prosthesis long term. Scarlett had to take off any prosthesis in order to sit down. She wanted to have a further amputation of the knee, and osseointegration at the same time, so that she could have a better prosthesis with an electronic knee and ankle.

Scarlett disliked using a socket as it was difficult to get on and off, took a long time and she found it to be very sweaty and uncomfortable. Her stump changed in volume frequently and she found that she would have to pack the socket with socks.

Osseointegration involves inserting a metal implant into the remaining bone. This implant supports the prosthetic limb, which can be put on or taken off using an Allen key with a quarter turn – no more compression bandages and liners and socks or sweat. It is not currently offered on the NHS and has to be done privately.

Because her growth plates had closed, Scarlett was a suitable candidate for surgery, and she went from a below knee amputation to an above knee amputation with osseointegration. At the same as the osseointegration, a procedure called targeted muscle reinnervation (TMR) was carried out. This moved the nerves cut by the amputation into the muscles and, as a result, Scarlett’s pain, and phantom pain that she had before, has largely resolved. She now has the odd instance of phantom sensation as opposed to being so fatigued by pain that she would have to miss school.

Just four months after her operation, Scarlett is walking about on her prosthetic limb, which has an electronic knee and ankle, without crutches. She is happy, pain free, continuing with her rehabilitation, and can see a future for herself. She is about to move into adapted accommodation.

Scarlett came to us from a different firm of solicitors where she and her family were not happy with the progress of the case and where the previous solicitor did not fight the insurer’s assertion that she ought not to have the surgery.

Within 18 months of taking over the case, we had obtained proper expert evidence to support Scarlett’s wish for surgery, issued Court proceedings, issued an application for an interim payment and, following a contested interim payment application, secured interim funds of just under £585,000, which has funded the surgery and the prosthetics and the rental of an adapted house, large enough for Scarlett and her family of seven to move into.

Scarlett has a suite of downstairs rooms where she has a bedroom, her own wet room, a storage room for her equipment and a further room for therapies. She can have therapies and appointments at home without disturbing the household or the household disturbing her, allowing her to concentrate on maximising her recovery. Her case continues and her rehabilitation progresses.

The driver was charged with causing serious injury by dangerous driving and sentenced to a period of imprisonment.

James Gratton also acted for the first UK patient, and only the second in the world, to have simultaneous elective amputation and osseointegration back in 2017, which also took place following a successfully contested interim payment application. An amputee is not required to have a socket and have problems with a socket before having osseointegration, nor wait until the end of the case before acquiring adapted accommodation and suitable prostheses.

As well as obtaining interim payments, Hugh James is also able to advise on achieving maximum welfare benefits that might be due as a result of amputation and help with finances if a breadwinner is affected, whether as an injured person or as the spouse or parent looking after an injured person.

* The names and identifying details of the client have been changed to protect the privacy of individuals involved.

Author bio

James Gratton

Senior Associate

James Gratton is a senior associate in the Manchester office and specialises in catastrophic injury claims, involving brain injury, spinal injury, and limb amputation claims, and combinations of serious injuries sustained in a single accident, otherwise known as polytrauma claims. James can deal with cases which occur in any setting, whether accidents on the road, at work, or in a public place.

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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