Tuesday, April 30, 2013

Appeals Court Orders Increase in Pain and Suffering Award for Man who Fell from Subway Platform

By John Hochfelder

on On October 3, 2003, Clyde Davison stumbled and fell from the subway platform onto the tracks at Franklin Avenue in Brooklyn. Luckily for him, there was no train in the area and a police officer responded quickly finding the 50 year old man face down near the third rail apparently intoxicated.
Within a few minutes, before Davison could be moved, a train entered the station at about 20 miles per hour and its contact shoe clipped Davison severely injuring him causing fractures of his clavicle and scapula.

Here is a typical clavicle fracture:











In the ensuing lawsuit, the transit authority was found 70% at fault for plaintiff’s injuries and Davison was charged with 30% of the fault.
The trial judge disagreed and dismissed the case reasoning that plaintiff was the sole proximate cause of his state of intoxication and that he unreasonably and unforeseeably disregarded the police officer’s instructions to get up and away from the tracks. On appeal, though, in Davison v. New York City Transit Authority (2d Dept. 2009), the 70/30 split was reinstated.
Finally, in 2010, a damages only trial was held.
The jury heard testimony from plaintiff and doctors for both sides describing the nature of Davison’s clavicle and scapula injuries and their effect on his life. They rendered a pain and suffering verdict in the sum of $216,000 ($150,000 past – 6 years, $66,000 future – 22 years).
The plaintiff appealed, this time claiming that the jury’s award was inadequate and should be increased.
In Davison v. New York City Transit Authority (2d Dept. 2011), the appellate court has now agreed with plaintiff again and ordered an increase in his award from $216,000 to $450,000 ($275,000 past, $175,000 future).
The net award to plaintiff, in view of his 30% comparative negligence, is $315,000.
The decision merely mentioned that plaintiff sustained fractures of his clavicle and scapula. Here are the details of Davison’s injuries:
  • comminuted fracture of the left clavicle requiring surgery to repair with a steel plate and screws
  • comminuted fracture of the left scapula requiring surgery to repair with two steel plates and screws
  • 27 day hospitalization
  • outpatient hospital physical therapy for two months
  • severely restricted movement and pain in the left arm with inability to perform normal household chores.
X-Ray showing the scapula after surgery like the one underwent by Mr. Davison:





The defense argued that the jury’s award was adequate because plaintiff’s fractures had healed, he was not suffering from any significant disability, he had no medical treatment for his injuries since August 2004 and any pain he still suffered from at trial was from prior unrelated injuries (of which there were many, including eight motor vehicle accidents and one that required neck surgery).
We’ve discussed clavicle and scapula injuries before, here and here.
Inside Information:
  • Defendant had offered $250,000 to settle the case before beginning the trial (a pretty good approximation of how the case would end up).
  • At the damages trial, plaintiff was cross-examined concerning his alcohol use (he admitted he had a history of chronic alcoholism) and his drug use, matters objected to at trial and on appeal but ultimately not addressed by the appellate court.

http://www.newyorkinjurycasesblog.com/2011/12/articles/clavicle-injuries/appeals-court-orders-increase-in-pain-and-suffering-award-for-man-who-fell-from-subway-platform/



POSTED BY ATTORNEY RENE G. GARCIA
Some of our clients have suffered these kinds of injuries due to a serious accident or malpractice. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.



































Wrist replacement

Definition

Wrist replacement surgery is performed to replace a wrist injured or damaged beyond repair. An artificial wrist joint replacement is implanted.

Purpose   

Traumatic injuries or severe degenerative diseases affecting the wrist (such as osteoarthritis and rheumatoid arthritis with bony destruction) may require replacement of the painful wrist joint with an artificial wrist joint. The purpose of wrist replacement surgery is to restore wrist motion for activities of daily living and non-contact sports. A wrist replacement recovers lost strength by restoring length to the muscles and tendons of the fingers and wrist, maintains a useful arc of motion and provides the stability required for an active life.

Description

Surgery to replace a wrist starts with an incision through the skin on the back of the wrist. The surgeon then moves the tendons extending over the back of the wrist out of the way to access the joint capsule on the back of the wrist joint, which is then opened to expose the wrist joint area. A portion of the carpal bones and the end of the radius and ulna are then removed from the wrist to allow room for the new artificial wrist joint. The bones of the hand and the radius bone of the forearm are prepared with the use of special instruments to form holes in the bones; the stems of the artificial joint components can then fit in. Next, the components are inserted into the holes. After obtaining a proper fit, the surgeon verifies the range of motion of the joint to ensure that it moves correctly. Finally, the surgeon cements the two sides of the joint and replaces the tendons back into their proper position before closing the wound.
A total wrist replacement implant consists of the following components:
  • An ellipsoid head that simulates the curvature of the natural wrist joint and allows for a functional range of motion. This ensures that the patient may flex and extend the wrist and move it side-to-side.
  • An offset radial stem that anchors the implant in the forearm. The special shape of this component is designed to assist the function of the tendons used to extend the wrist and to ensure the stability of the implant.
  • An elongated radial tray surface with a molded bearing usually made of polyethylene. This component is required to distribute forces over the entire surface of the artificial joint.
  • A fixation stem that is secured to the patient's bone to add stability and eliminate rotation of the artificial joint within the bone.
  • A curved metacarpal stem that secures the artificial wrist within the hand.

Diagnosis/Preparation

The orthopedic surgeon who will perform the surgery will usually require a complete physical examination of the patient by the primary care physician to ensure that the patient will be in the best possible condition to undergo the surgery. The patient may also need to see the physical therapist responsible for managing rehabilitation after wrist replacement. The therapist prepares the patient before surgery to ensure readiness for rehabilitation post-surgery. The purpose of the preoperative examination is also for the physician to pre-record a baseline of information that will include measurements of the patient's current pain levels, functional wrist capacity, and the range of motion and strength of each hand.
Before surgery, patients are advised to take all of their normal medications, with the exception of blood thinners such as aspirin , ibuprofen, and other anti-inflammatory drugs that may cause greater blood loss during surgery. Patients may eat as they please the night before surgery, including solid food, until midnight. After midnight, patients should not eat or drink anything unless told otherwise by their doctor.

Aftercare

Following surgery, the patient's wrist, hand, and lower arm are placed into a bulky bandage and a splint. A small plastic tube may be inserted to drain any blood that gathers under the incision to prevent excessive swelling (hematoma). The tube is usually removed within 24 hours. Sutures may be removed 10–14 days after surgery.

Risks

Some of the most common risks associated with wrist replacement surgery are:
  • Infection. Infection can be a very serious complication following wrist replacement surgery. Infection following wrist replacement occurs in approximately 1–2% of cases. Some infections may appear before the patient leaves the hospital, while others may not become apparent for months, or even years, after surgery.
  • Loosening. There is also a risk that the artificial joints may eventually fail, due to a loosening process where the metal or cement meets the bone. There have been great advances in extending how long an artificial joint will last, but most will eventually loosen and require revision surgery. The risk of loosening is much greater in younger, more active people. A loose artificial wrist is a problem because of the resulting pain. Once the pain becomes unbearable, another operation is usually required to either revise the wrist replacement or perform a wrist fusion.
  • Nerve injury. All of the nerves and blood vessels that go to the hand travel across the wrist joint. Wrist replacement surgery is performed very close to these structures, introducing a risk of injury either to the nerves or the blood vessels.

Normal results

Wrist replacement surgery often succeeds at restoring wrist function. On average, a wrist replacement is expected to last for 10–15 years.

Alternatives

An alternative to wrist replacement is wrist fusion (arthrodesis). Wrist fusion surgery eliminates pain by allowing the bones that make up the joint to grow together, or fuse, into one solid bone. The surgery reduces pain, but also reduces the patient's ability to move the wrist. Wrist fusions were very common before the invention of artificial joints, and they are still performed often.
See also Arthroplasty .

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Wrist replacement surgery is performed by an orthopedic surgeon in an orthopedic hospital or in a specialized clinic.


Read more: http://www.surgeryencyclopedia.com/St-Wr/Wrist-Replacement.html#ixzz2Rz0xSdwO


Monday, April 29, 2013

Finger reattachment

Definition

Finger reattachment (or replacement) is defined as reattachment of the part that has been completely amputated.

Purpose

Replantation refers to reattachment of a completely severed part, meaning there is no physical connection between the part that has been cut off and the person. Reattachment can be surgically performed for the finger and such other detached body parts, as the hand or arm.

Demographics

Good candidates for this procedure include persons with thumb or multiple digit amputation . Injury to multiple digits is an important patient selection criterion, since in some cases the least damaged digits may be shifted to the least injured or most useful stump. Patient exclusion is neither clear-cut nor absolute. Generally, severe crushing or avulsing (tearing away) injuries to the fingers may make replantation difficult, but venous grafts may help replace injured blood vessels. Additionally, older persons may have arteriosclerosis that frequently impairs function in blood vessels, especially in small vessels. Special efforts may be made to replant fingers if the person's livelihood (such as professional musical performance) depends on absolute finger control.

Description

To increase efficiency, the replantation team splits into two sub-teams. One sub-team in the operating room cleans the amputated finger with sterile solutions, places it on ice, and identifies and tags (with special surgical clips) nerves and blood vessels. Dead or damaged tissue is surgically removed with a procedure called debridement . The emergency room (ER) sub-team will assess the patient during a physical exam with x rays of the injured area, blood analysis, and cardiac (heart) monitoring. The patient is given fluids intravenously (IV), a tetanus injection, and antibiotics . Usually, most finger reattachments are performed with a local anesthetic such as bupivacaine and a nerve block to numb the affected arm. Maintaining a warm body temperature can enhance blood flow to the affected limb.
The surgical procedure consists of several stages. The bone in the amputated finger must be shortened and fixed, which means that the bone end is trimmed. After this process, the bone is stabilized with special sutures called K-wires, and fixed pins are placed in the bone after drilling a space to insert them. This process connects the two amputated bone fragments. After bone stabilization and fixation, the extensor and flexor tendons are repaired. This step is vital, since arteries, veins, and nerves should never be surgically connected under tension. Next, the surgeon must repair (suture) cut-off tendons, arteries, veins, and nerves. Healthy arteries and veins are sutured together without tension. A vein graft is used for blood vessels that cannot be reattached.
Nerve repair for finger reattachment is not difficult. Since the reattached bone parts are shorter than the original length, nerves can be reattached without tension. A microscope is used for magnified visualization of finger nerves during reattachment. When the severed ends of the nerve cannot be reattached, a primary nerve graft is performed. Finally, it is vital superficial veins on the affected finger (dorsal veins) to cover with a skin flap to prevent death of the venous vessels. The skin over the surgical field is loosely sutured with a few sutures. Any damaged tissue that may die (necrotic tissue) is removed. No tension should be placed on the skin fields during closure of the wound. Wounds are covered with small strips of gauze impregnated with petrolatum. The upper extremity is immobilized, and compression hand dressing and plaster splints are arranged to prevent slipping and movement of the affected arm.

Diagnosis/Preparation

The diagnosis is easily made by visual inspection since the finger(s) must be completely detached from the hand. The reattachment procedure is complex and involves the expertise and skill of a highly trained surgeon. There are several important factors necessary to successful replantation, including special instrumentation and transportation of the amputated finger. Surgical loupes (binocular-type eyepieces used by surgeons to magnify small structures during surgery) are necessary for this procedure. Instruments should be at least 3.9 in (10 cm) long to allow for proper positioning in the surgeon's hands. Special clips are used to help suture blood vessels together. The best method of saving and transporting the amputated finger is to wrap it with moistened cloth (Ringer's lactate solution or saline solution) and place it on ice. Generally, the tissues will survive for about six hours without cooling. If the part is cooled, tissue survival time is approximately 12 hours. Fingers have the best outcome for transportation survival, since digits (fingers) do not have a large percentage of muscle tissue.

Aftercare

Postoperative care is vital for successful finger reattachment. The hand is wrapped in a bulky compression dressing and usually elevated. If arterial flow is impaired, then the hand should be lowered, since this maneuver will promote blood flow from the heart to the reattached finger. If venous outflow is slow, the hand must be elevated. Medications to increase blood flow (peripheral vasodilators) and an anticoagulant (heparin) are used. A tranquilizer may be given to reduce unnecessary blood vessel movement (vasospasm) that can occur due to anxiety. Careful examination of the reattached digit(s) is necessary. The surgeon frequently monitors color, the capacity of blood vessels, capillary refill, and warmth to monitor replant progress. The YSI telethermometer monitors the digital (finger) temperature with small surface probes. Skin temperature falling below 86°F (30°C) indicates poor blood perfusion

Read more: http://www.surgeryencyclopedia.com/Fi-La/Finger-Reattachment.html#ixzz2RbfTG1Gk

POSTED BY ATTORNEY RENE G. GARCIA
Some of our clients have suffered these kinds of injuries due to a serious accident or malpractice. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

Shoulder resection arthroplasty

Definition

Shoulder resection arthroplasty is surgery performed to repair a shoulder acromioclavicular (AC) joint. The procedure is most commonly recommended for AC joint problems resulting from osteoarthritis or injury.

Purpose

The shoulder consists of three bones: the shoulder blade, the upper arm bone (humerus), and the collarbone (clavicle). The part of the shoulder blade that makes up the roof of the shoulder is called the acromion and the joint where the acromion and the collarbone join is called the acromioclavicular (AC) joint.
Some joints in the body are more likely to develop problems due to normal wear and tear, or deterioration resulting from osteoarthritis, a progressive and degenerative joint disease. The AC joint is a common target for developing osteoarthritis in middle age. This condition can lead to pain and difficulty using the shoulder for everyday activities. Besides osteoarthritis, AC joint disease (arthrosis) may develop from an old injury to the joint such as an acromioclavicular dislocation, which is the disruption of the normal articulation between the acromion and the collarbone. This type of injury is quite common in competitive sports, but can also result from a simple fall on the shoulder.
The goal of shoulder resection arthroplasty is to restore function to an impaired shoulder, with its required motion range, stability, strength, and smoothness.

Demographics

According to the National Ambulatory Medical Care Survey, osteoarthritis is one of the most common confirmed diagnoses in individuals over the age of 65, with the condition starting to develop in middle age.
As for AC joint injuries, they are seen especially in such professional athletes as football or hockey players, and occur most frequently in the second decade of life. Males are more commonly affected than females, with a male-to-female ratio of approximately five to one.

Description

A resection arthroplasty involves the surgical removal of the last 0.5 in (1.3 cm) of the collarbone. This removal leaves a space between the acromion and the cut end of the collarbone where the AC joint used to be. The joint is replaced by scar tissue, which allows movement to occur, but prevents the rubbing of the bone ends. The end result of the surgery is that the flexible connection between the acromion and the collarbone is restored. The procedure is usually performed by making a small 2 in (5 cm) incision in the skin over the AC joint. In some cases, the surgery can be done arthroscopically. In this approach, the surgeon uses an endoscope to look through a small hole into the shoulder joint. The endoscope is an instrument of the size of a pen, consisting of a tube fitted with a light and a miniature video camera, which transmits an image of the joint interior to a television monitor. The surgeon proceeds to remove the segment of collarbone through a small incision with little disruption of the other shoulder structures.

Diagnosis/Preparation

The diagnosis is made by physical exam. Tenderness over the AC joint is usually present, with pain upon compression of the joint. X rays of the AC joint may show narrowing of the joint and bone spurs around the joint. A magnetic resonance imaging (MRI) scan may also be performed. An MRI scan is a special imaging test that uses magnetic waves to create pictures that show the tissues of the shoulder in slices and has the advantage of showing tendons as well as bones. In some cases, an ultrasound test may be also be performed to inspect the soft tissues of the joint.
Prior to arthroplasty surgery, all the standard preoperative blood and urine tests are performed. The patient also meets with the anesthesiologist to discuss any special conditions that may affect the administration of anesthesia.

Aftercare

The rehabilitation following surgery for a simple resection arthroplasty is usually fairly rapid. Patients should expect the soreness to last for three to six weeks. Postoperatively, patients usually have the affected arm in a sling for two weeks. Thereafter, a progressive passive range of shoulder motion exercise is started, usually with range-of-motion exercises that gradually evolve into active stretching and strengthening. The patient's arm remains in the sling between sessions. At six weeks, healing is sufficient to encourage progressive functional use. Physiotherapy usually continues until range of motion and strength are maximized. The therapist may also use massage and other types of hands-on treatments to ease muscle spasm and pain. Heavy physical use of the shoulder is prohibited for an additional six weeks.

Risks

Patients who undergo shoulder resection arthroplasty are susceptible to the same complications associated with any such surgery. These include wound infection, osteomyelitis, soft tissue ossification, and failure of fixation (remaining in place), with recurrent deformity. Symptomatic AC joint arthritis may develop in patients who undergo the surgery as a result of injury.
Specific risks associated with shoulder resection arthroplasty include:
  • Fractures. Fractures of the humerus may occur after surgery, although the risk is considered low.
  • Shoulder instability. Early shoulder dislocations may occur during the early postoperative period due to soft tissue imbalance or to inadequate postoperative protection; late dislocation may result from glenoid cavity wear.
  • Degenerative changes. Progressive degeneration of the AC joint is a common late complication.

Normal results

Shoulder resection arthroplasty is generally very effective in reducing pain and restoring motion of the shoulder.

Morbidity and mortality rates

In a recent four-year follow-up study on shoulder arthroplasty patients, all patients experienced relief from pain. Functional improvement was good in 77% of patients. Average shoulder abduction improved from 37–79° and forward flexion from 52–93°. No deaths resulting from shoulder resection arthroplasty have ever been reported.

Alternatives

Non-surgical treatments

Doctors commonly attempt to treat AC joint problems using conservative treatments. Patients may be prescribed such anti-inflammatory medications as aspirin or ibuprofen. Treatment also may include such diseasemodifying drugs as methotrexate, sulfasalazine and gold injections. Researchers are also working on biologic agents that can interrupt the progress of osteoarthritis. These agents target specific chemicals in the body to prevent them from acting on the joints. Resting the sore joint and applying ice to it can also ease pain and inflammation. Injections of cortisone into the joint may also be prescribed. Cortisone is a strong steroidal medication that decreases inflammation and reduces pain. The effects of the drug are temporary, but it provides effective relief in the short term. Physicians may also prescribe sessions with a physical or occupational therapist, who may use various treatments to relieve inflammation of the AC joint, including heat and ice.

Surgical alternatives

Alternative surgical approaches include replacing the entire shoulder joint with a prosthesis (total shoulder arthroplasty) or replacing the head of the humerus (hemiarthroplasty).
See also Arthroplasty ; Shoulder joint replacement .

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Shoulder resection arthroplasty is performed in a hospital. It is performed by experienced orthopedic surgeons who are specialists in AC joint problems. Some medical centers specialize in joint surgery and tend to have higher success rates than less specialized centers.

Read more: http://www.surgeryencyclopedia.com/Pa-St/Shoulder-Resection-Arthroplasty.html#ixzz2Rs0WQD3c


POSTED BY ATTORNEY RENE G. GARCIA
Some of our clients have suffered these kinds of injuries due to a serious accident or malpractice. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

Friday, April 26, 2013

Hand surgery

Definition

Hand surgery refers to procedures performed to treat traumatic injuries or loss of function resulting from such diseases as advanced arthritis of the hand.

Purpose

The purpose of hand surgery is the treatment of a broad range of problems that affect the hand, whether they result from cuts, burns, crushing injuries to the hand, or disease processes. Hand surgery includes procedures that treat traumatic injuries of the hands, including closed-fist injuries; congenital deformities; repetitive stress injuries; deformities caused by arthritis and similar disorders affecting the joints; nail problems; and tendon repair .
The central priority of the hand surgeon is adequate reconstruction of the skin, bone, nerve, tendon, and joint(s) in the hand. Proper repair of any cuts, tears, or burns in the skin will help to ensure a wound free of infection and will provide cover for the anatomical structures beneath the skin. Early repair and grafting is an essential component of hand surgery. Nerve repair is important because a delay in reconnecting the nerve fibers may affect the recovery of sensation in the hand. Restoration of sensation in the hand is necessary if the patient is to recover a reasonable level of functionality. Next, the bones in the hand must be stabilized in a fixed position before the surgeon can repair joints or tendons. Joint mobility may be restored by specific tendon repairs or grafts. In some cases, the patient's hand may require several operations over a period of time to complete the repair.


Demographics

The demographics of hand injuries and disorders depend on the specific injury or disorder in question. Repetitive stress injuries (RSIs) of the hands are often related to occupation; for example, nurse anesthetists, dental hygienists, keyboard instrumentalists, word processors, violinists, and some assembly line workers are at relatively high risk of developing carpal tunnel syndrome or tendinitis of the fingers related to their work. Nearly 17% of all disabling work injuries in the United States involve the fingers, most often when the finger strikes or is jammed against a hard surface. Over 25% of athletic injuries involve the hand or wrist.
In terms of age groups, children under the age of six are the most likely to be affected by crushing or burning injuries of the hand. Closed-fist injuries, which frequently involve infection of the hand resulting from a human bite, are almost entirely found in males between the ages of 15 and 35. Pain or loss of function in the hands resulting from osteoarthritis, however, is found most often in middle-aged or older adults, and affects women as often as men.
Some specific categories of conditions that may require hand surgery include:
Congenital malformations. The most common congenital hand deformity is syndactyly, in which two or more fingers are fused together or joined by webbing; and polydactyly, in which the person is born with an extra finger, often a duplication of the thumb.
Infections. Hand surgeons treat many different types of infections, including paronychia, an infection resulting from a penetrating injury to the nail; felon, an inflammation of the deeper tissue under the fingertip resulting in an abscess; suppurative tenosynovitis, an infection of the flexor tendon sheath of the fingers or thumb; and deeper infections that often result from human or animal bites.
Tumors. The most common tumor of the hand is the ganglion cyst, which is a mass of tissue fluid arising from a joint or tendon space. Giant cell tumors are the second most common hand tumor. These tumors usually arise from joints or tendon sheaths and are yellow-brown in color. The third type of hand tumor is a lipoma, which is a benign tumor that occurs in fatty tissue.

Nerve compression syndromes. These syndromes occur when a peripheral nerve is compressed, usually because of an anatomic or developmental problem, infection or trauma. For example, carpal tunnel syndrome develops when a large nerve in the arm called the median nerve is subjected to pressure building up inside the carpal tunnel, which is a passageway through the wrist. This pressure on the nerve may result from injury, overuse of the hand and wrist, fluid retention during pregnancy, or rheumatoid arthritis. The patient may experience tingling or aching sensations, numbness, and a loss of function in the hand. The ulnar nerve is another large nerve in the arm that runs along the little finger. Compression of the ulnar nerve at the elbow can cause symptoms that typically include aching pain, numbness and paresthesias.
Amputation . Some traumatic injuries result in the loss of a finger or the entire hand, requiring reattachment or replantation. Crushing injuries of the hand have the lowest chance of a successful outcome. Children and young adults have the best chances for recovery following surgery to repair an accidental amputation.
Fractures and dislocations. Distal phalangeal fractures (breaking the bone of a finger above the first joint towards the tip of the finger) are the most commonly encountered fractures of the hand. They often occur while playing sports.
Fingertip injury. Fingertip injuries are extremely dangerous since they comprise the most common hand injuries and can lead to significant disability. Fingertip injuries can cause damage to the tendons, nerves, or veins in the hands.

Description

There are a number of different procedures that may be involved in hand surgery, with a few general principles that are applicable to all cases: operative planning; preparing and draping the patient; hair removal; tourniquet usage; the use of special surgical instruments ; magnification (special visualization attachments); and postoperative care . The operative preplanning stage is vitally important since it allows for the best operative technique. The hand to be operated on is shaved and washed with an antiseptic for five minutes. A tourniquet will be placed on the patient's arm to minimize blood loss; special inflation cuffs are available for this purpose.
The four basic instruments used in hand surgery include a knife, small forceps, dissecting scissors, and mosquito hemostats. A standard drill with small steel points is used to drill holes in bone during reconstructive bone surgery. Additionally, visualization of small anatomical structures is essential during hand surgery. Frequently, the hand surgeon may use wire loupes (a special instrument held in place on top of the surgeon's head) or a double-headed binocular microscope in order to see the tendons, blood vessels, muscles, and other structures in the hand.
In most cases, the anesthesiologist will administer a regional nerve block to keep the patient comfortable during the procedure. The patient is usually positioned lying on the back with the affected arm extended on a hand platform. If the surgeon is performing a bone reconstruction, he or she may require such special instruments as a drill, metal plates and/or screws, and steel wires (K-wires). Arteries and veins should be reconnected without tension. If this cannot be done the hand surgeon must take out a piece of vein from another place in the patient's body and use it to reconstruct the vein in the hand. This process is called a venous graft. Nerves damaged as a result of traumatic finger injuries can usually be reconnected without tension, since bone reconstruction prior to nerve surgery shortens the length of the bones in the hand. The surgeon may also perform skin grafts or skin flaps. After all the bones, nerves, and blood vessels have been repaired or reconstructed, the surgeon closes the wound and covers it with a dressing.

Diagnosis/Preparation

With the exception of emergencies requiring immediate treatment, the diagnosis of hand injuries and disorders begins with a detailed history and physical examination of the patient's hand. During the physical examination, the doctor evaluates the range of motion (ROM) in the patient's wrist and fingers. Swollen or tender areas can be felt (palpated) by the clinician. The doctor can assess sensation in the hand by very light pinpricks with a fine sterile needle. In cases of trauma to the hand, the doctor will inspect the hand for bite marks, burns, foreign objects that may be embedded, or damage to deeper anatomical structures within the hand. The tendons will be evaluated for evidence of tearing or cutting. Broken bones or joint injuries will be tender to the touch and are easily visible on x-ray imaging.
The doctor may order special tests, including radiographic imaging (x rays), wound culture , and special diagnostic tests. X rays are the most common and most useful diagnostic tools available to the hand surgeon for evaluating traumatic injuries. Wound cultures are important for assessing injuries involving bites (human or animal) as well as wounds that have been badly contaminated by foreign matter. Such other special tests as a Doppler flowmeter examination can be used to evaluate the patterns of blood flow in the hand.
Before a scheduled operation on the hand, the patient will be given standard blood tests and a physical examination to make sure that he or she does not suffer from a general medical condition that would be a contraindication to surgery.

 Aftercare
Aftercare following hand surgery may include one or more of the following, depending on the specific procedure: oral painkilling medications; anti-inflammatory medications; antibiotics ; splinting; traction ; special dressings to reduce swelling; and heat or massage therapy. Because the hand is a very sensitive part of the body, the patient may experience severe pain for several days after surgery. The surgeon may prescribe injections of painkilling drugs to manage the patient's discomfort.
Exercise therapy is an important part of aftercare for most patients who are recovering from hand surgery. A rehabilitation hand specialist will demonstrate exercises for the hand, instruct the patient in proper wound care , massage the hand and wrist, and perform an ongoing assessment of the patient's recovery of strength and range of motion in the hand.


Risks

According to the American Society of Plastic Surgeons, the most common complications associated with hand surgery are the following:
  • infection
  • poor healing
  • loss of sensation or range of motion in the hand
  • formation of blood clots
  • allergic reactions to the anesthesia
Complications are relatively infrequent with hand surgery, however, and most can be successfully treated.

Normal results

Normal results for hand surgery depend on the nature of the injury or disorder being treated.

Morbidity and mortality rates

Mortality following hand surgery is virtually unknown. The rates of complications depend on the nature of the patient's disorder or injury and the specific surgical procedure used to treat it.

Alternatives

Some disorders that affect the hand, such as osteoarthritis and rheumatoid arthritis, may be managed with such nonsurgical treatments as splinting, medications, physical therapy, or heat. Fractures, amputations, burns, bite injuries, congenital deformities, and severe cases of compression syndromes usually require surgery.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Hand surgery is usually performed by a microsurgeon, who may be a plastic surgeon (a surgeon with five years of general surgery training plus two years of plastic surgery training and another one to two years of training in microneurovascular surgery) or an orthopedic surgeon (a surgeon with one year of general surgery training, five years of orthopedic surgery training and additional years in microsurgery training).
Hand therapists are usually occupational therapists who have received specialized training in hand rehabilitation and are certified in hand therapy.

QUESTIONS TO ASK THE DOCTOR


  • Are there any alternatives to surgery for treating my hand?
  • Is the disorder likely to recur?
  • Will I need a second operation?
  • How many patients with my condition have you treated, and what were their outcomes?
  • Can I expect to recover full range of motion in my hand?
  • What will my hand look like after surgery?


 POSTED BY ATTORNEY RENE G. GARCIA
Some of our clients have suffered these kinds of injuries due to a serious accident or malpractice. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.



Thursday, April 25, 2013

Finger Amputation Cases – Pain and Suffering Awards Range from $85,000 to $2,000,000


The first thing many new mothers ask, even before seeing their newborns, is: "Are there 10 fingers (and toes)?" Of course, the answer is almost always "yes." Fingers can, though, be lost – amputated – later in life and when that happens it’s usually due to an accident with a lawnmower or a power saw. And then the lawsuits follow.
As usual, we focus here on how pain and suffering is evaluated by juries and judges in New York injury cases. And as you might have guessed already, this post will discuss recent finger amputation cases. While that seems like a narrow topic, and one that might result in a small range of monetary recoveries, the opposite is the fact. That’s because some cases involve amputations of just one (or just part of one) finger; while others involve two, three or more fingers. Then, there’s the issue of which finger – we all know that thumbs, for example, are much more important to function than pinky fingers.
For a review of  hand and finger anatomy, see our post on hand injury pain and suffering verdicts here which includes diagrams of the phalanges (the finger bones).
The most recent case, Nisanov v. Black & Decker (U.S.), Inc. involved a 31 year old man who was using an old electric corded lawn mower. After mowing the lawn one day, Mr. Nisanov turned the mower upside down and began to remove grass clippings that had accumulated. Despite a warning on the machine of which he was aware, he did not unplug the mower and its blades restarted while he was removing the clippings. He suffered total amputations of his left hand’s index, middle and right fingers, his left pinky was partially severed and his left thumb was lacerated. The jury found that Mr. Nisanov’s pain and suffering damages totaled $2,000,000 ($600,000 past, $1,400,000 future) but it also found that Black & Decker was negligent in its design of the mower but it also found that Mr. Nisanov was 90% at fault for his own injury. Therefore, his net recovery was $200,000 (10% of the pain and suffering sum).
Do not stick your hand into a lawnmower or you may come out missing fingers:

Nisanov  made a post-trial motion challenging the 90% comparative negligence finding against him as well as the jury’s $600,000 past pain and suffering verdict. He contended that $600,000 was too low for his pain and suffering for the five year period from the date of the accident to the date of the verdict. He did challenge the future pain and suffering figure.
On April 9, 2009, the trial judge issued a decision on the motion in the Nisanov case finding that the $600,000 past pain and suffering award was within the range of reasonableness and would not be modified. Also, the judge declined to disturb the jury’s finding that plaintiff was 90% at fault. There will be no appeal.
In McKeon v. Sears, Roebuck & Co., a carpenter had four fingers of his dominant hand fully amputated and reattached. There, the jury verdict of $1,350,000 ($810,000 past, $540,000 future) was upheld by the appellate court. That decision was relied upon by the plaintiff in the Nisanov post-trial motion for the proposition that $600,000 was unreasonable for five years of pain and suffering. While the injuries appear to have been similar, the $210,000 difference between the two past pain and suffering awards was not significant enough for a trial judge or an appellate court to step in and modify upward. The courts will modify upward or downward only when the jury verdict is not in a range of figures that is reasonable.
Here are the other important finger amputation cases insofar as pain and suffering damages is concerned:
  •  Hudson v. Lansingburgh Central School District$240,000 Rensselear County jury verdict for pain and suffering ($90,000 past, $150,000 future) affirmed for a 14 year old boy who cut off a portion of the middle finger of his nondominant hand while operating a jointer-planer in technology class. He underwent surgery to amputate the finger at the proximal interphalangeal joint, which separates the lower and upper halves of the finger. Plaintiff was found to be 35% at fault so the his actual recovery was reduced to $156,000.
  • Bradshaw v. 845 U.N. Limited Partnership$85,000 ($50,000 past, $35,000 future) upward modification by appellate court for pain and suffering involving the amputation of the distal portion of plaintiff’s ring finger following a workplace accident in which a rebar caught on and partially severed the finger. The Manhattan jury had returned a verdict of $50,000 for past pain and suffering but nothing at all for for the future. The appeals court fond $35,000 should be added because the plaintiff would experience hypersensitivity in the remaining portion of the finger for the balance of her life.
  • Leon v. J&M Peppe Realty Corp. – $850,000 pain and suffering verdict ($100,000 past, $750,000 future) affirmed by appeals court for a 26 year old carpenter who suffered a partial amputation of his three middle fingers while working on a circular saw like this:   
    The Bronx County jury had awarded plaintiff $100,000 for his four years of past pain and suffering plus $1,500,000 for 40 years in the future. The trial judge, though, reduced the future award to $750,000 and it’s the trial judge’s $850,000 total that was affirmed by the higher court.
  • Huang v. Cherry Avenue Corp. (Index # 12201/05; Supreme Court, Queens County; 12/5/08) – $467,700 pain and suffering verdict ($200,000 past, $267,700 future) for a 42 year old mason in a construction site accident in which the tip of his left, nondominant hand’s index finger was detached after it became caught between a hoist’s hook and the hoisted material. Doctors were not able to reattach the detached portion of plaintiff’s finger and they shaved a portion of the exposed bone and sewed skin into the open wound.
Inside Info: Plaintiff was willing to settle before trial for $325,000 but defendants’ offer was only $75,000.
  • James v. Queens Long Island Medical Group (Index # 17741/03; Supreme Court, Queens County; 3/8/07) – $950,000 pain and suffering verdict ($350,000 past, $600,000 future – 19 years) for a 7 year old girl who fell at school and sustained a chip fracture of the proximal phalanx of the ring finger of her left, nondominant hand. Doctors splinted and wrapped her hand but when she returned for follow-up medical treatment two weeks later her finger was necrotic and she had to undergo a surgical amputation of the distal phalanx followed by several months of physical therapy. The jury found that the doctors had committed medical malpractice. The defense contended that the $950,000 verdict was excessive and made a post-trial motion to it set aside . During the pendency of that motion, the parties settled the case for $700,000.
  • Silverman v. State of New York $650,000 judge’s decision for pain and suffering ($250,000 past, $400,000 future) for a 44 year old prison inmate injured in a carpentry class while working with a table saw that did not have a safety guard. Plaintiff sustained amputations of the digits of his thumb, index, middle and ring fingers of his left, nondominant hand. The award was reduced by one-half due to plaintiff’s contributory negligence.
Finger amputation accidents are typically quite gruesome and can result in very significant pain and suffering verdicts that are sustainable. On the other hand (pun not intended), these cases often involve accidents in which there is a very significant amount of culpability on the plaintiff’s part and then the award will be reduced accordingly. We will continue to follow new finger amputation cases as they arise.

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Some of our clients have suffered these kinds of injuries due to a serious accident or malpractice. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.


What is a deposition and how do I prepare for mine?


Depositions are statements under oath, taken down in writing, that can be used in court. They are also known as examinations before trial or EBTs. You’re asked questions by the defendant’s lawyer and you give answers.  This will take place in a lawyer’s conference room with both attorneys present, along with a stenographer as well as any other parties to the lawsuit (if they want to be there and watch).
Depositions are governed in New York by CPLR Article 31 but for the client being deposed the importance of depositions lies not in legalisms but in preparation (yours and your lawyer’s) and what’s going to happen inside the room.
Here are 10 important things to know about depositions, all of which your lawyer should know and impart to you (before your EBT).
  1. The depositions of the plaintiff and the defendant are the most important aspects of your lawsuit, even more important than the trial itself. Deposition testimony will either be almost exactly what the party would testify to at trial or, if trial testimony varies significantly from EBT testimony, then it will subject you to a blistering, damaging and potentially fatal (to your case, that is) cross-examination. Get it right the first time (at your EBT).
  2. You must be prepared by your attorney before your EBT – not 10 minutes before – so that you understand nearly all of the questions you will be asked, you review in advance the facts of your case so that you are not hemming and hawing the entire time during your deposition and you know that your aim is to answer the defense attorney’s questions without volunteering anything and to do so in a way that makes a good, truthful and forthright impression.
  3. Let me expand on #2. You are to say little. Not much. Just answer the questions. If it’s a question that can be answered with the one word answer "yes" or the one word answer "no" then that’s all you say. If you are not sure or don’t know, then just say that: "I am not sure" or "I don’t know." That’s it. Nothing more. Not another word. And never, ever the word "because." Never say: "I don’t know because ….." That will open you up to a whole line of questioning that may be damaging.
  4. Make sure your attorney visited the scene of your accident well in advance of your EBT and is extremely familiar with all of the facts. It is so obvious when a lawyer has not for example been to the scene of a car accident and fails to ask questions that one having seen the curves in the road or the obstructions there would have known about. Huge errors are made without preparation.
  5. Do not allow yourself to get rattled or upset. One of the most important things you can accomplish is to have defense counsel write in his report to his insurance carrier (it’ll be done that very day) that you appear to be straightforward and will make a good impression on the jury. If everyone agreed on the facts of your accident, you probably wouldn’t be in a lawsuit, so the jury will have to decide whose version is correct or truthful. The jury will be affected by your appearance and demeanor. So will defense counsel and therefore the defense insurance company who may offer to settle after your favorable EBT (or dig in and forge ahead to trial after your unfavorable EBT).
  6. Do not lie about any significant facts. Do not lie about any insignificant facts. Do not lie. Period. It will come back to haunt you. Big time. Evan Schaeffer, a noted St. Louis attorney who writes extensively about depositions, advises attorneys to assume all witnesses are lying and to wear down witnesses with questions until the truth comes out. Do not lie.
  7. Do not have a diary or any other writing with you that you want to refer to or look at during your deposition. That will allow defense counsel to demand to see the entire thing and question you about it line by line.
  8. Your attorney will probably tell you to call  his office the day before to confirm your deposition appointment. That’s because depositions are often adjourned by defense counsel for many reasons – juggling a huge caseload, intentional attempts to delay the case, office scheduling errors and the like. Be patient. Your own time is of course very important and to be respected but when these delays occur you will have to swing with them. Your attorney will know when to get the judge involved for you.
  9. Understand that lawyers at EBTs are given wider latitude than they are at trial insofar as the relevance of questions is concerned. They are permitted in depositions to explore areas to try to find relevant information or questions that wold lead to relevant information so don’t expect your lawyer to be objecting and preventing questions that you think aren’t directly relevant to your case.
  10. Relax. Victoria Pynchon, author of Settle It Now Negotiation Blog and full-time attorney-mediator, suggests that a "winning" deposition, one that was approached with great preparation and at which some points were scored, is often the only win that will be needed - cases can and often do settle after successful depositions. So, be comfortable knowing that the truth will prevail and that if you and your lawyer have properly prepared for your EBT (and the defendant’s) then you are likely on your way to winning your case (or at least to negotiating a good settlement).
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                                                POSTED BY ATTORNEY RENE G. GARCIA



The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.