Medical
Email your opinions to
editorial@barkerbrooks.co.uk
Te right fit Mark Bowman explains the intricacies of a case involving a transfemoral amputee claimant who required osseointegration, a form of surgery which is no longer available in the UK
crushed him. Emergency service workers were able to free Mr B from the wreckage before he was taken by air ambulance to hospital. Following resuscitation, his left foot was noted
M
Mark Bowman is a partner in the Medical Negligence and Personal Injury department at Field Fisher Waterhouse LLP. He specialises in catastrophic injury claims
Mark.Bowman@
ffw.com
to be pulseless and his lower leg was deemed unsalvageable. He required a transfemoral amputation. Mr B remained in hospital for four months
before being transferred to a rehabilitation centre where he started to receive prosthetic support on the NHS. Unfortunately, the socket for his left leg continuously proved to be a challenge and Mr B was not provided with a comfortable replacement.
Socket problems Swelling of the stump is normal following any
amputation. Residual limb shrinkage is inevitable and varies from patient to patient, sometimes lasting years. The socket is the receptacle for the amputee’s residual limb, and forms the interface with the prosthesis. It is generally agreed that the socket is the
most important part of any prosthesis. The socket may be constructed from a number of materials. The shape of the socket is vital and must provide stability for the residual limb within the socket so that the amputee may transfer his own movements into functional prosthetic movements. If the socket fails to fulfil these requirements, not even the most sophisticated prosthesis will function properly. As a result of Mr B's socket problems, he was
largely confined to a wheelchair and unable to mobilise. His rehabilitation was delayed and he slumped into depression. Mr B was discharged from hospital on 23
December 2008 with an NHS prosthesis. He needed to wear two thick towelling socks between the liner and the socket to ensure that a fit was achieved, but this was unsatisfactory. Below the socket, Mr B was provided with a standard pneumatically controlled
48 /Claims Magazine/Issue 11
r B was injured at work in June 2008. He was operating a telescopic handler on a building site which toppled over and
aluminium prosthesis and rubber foot. This proved unreliable and he fell on numerous occasions. Mr B was assessed for private prostheses, and
these were purchased in early 2009. In spite of this, he suffered from dermatitis, pain and immobilisation at times. Despite being continually assessed over the next 12 months, no solution could be found to his problems. As a result of this, extensive research was
conducted by Mr B's legal and rehabilitation team to examine the alternatives. Using a wheelchair frequently was not an option for him. Osseointegration was deemed the only potential
solution to Mr B's ongoing issues as he did not qualify for the ITAP programme available in the UK as he was involved in a personal injury claim, which automatically excluded him.
Osseointegration Osseointegration was initially discovered by
Professor Branemark in 1952. In short, he conducted an experiment where he utilised a titanium implant to study blood flow in rabbit bone. At the conclusion of the study, he discovered that the bone had integrated with the titanium so that the latter could not be removed. He started to develop this process initially in the field of dentistry, but then in orthopaedics. The treatment process has been available in
Sweden since 1990 but it is since 1999 that the primary concern, infection, has been greatly reduced. The process involves the insertion of a titanium
rod into the femur. Following insertion the titanium rod and bone integrate, meaning there is no need to use a socket when fitting a prosthetic limb. Such treatment was, at one stage, available in the UK, but following a trial, the programme was ended and the nearest location for such treatment was in fact the Branemark Osseointegration Centre in Sweden. Mr B was offered an appointment in Sweden in
December 2010. I was concerned that there would be problems securing funding for such treatment from the Defendant, as such a request had not, it
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60