EWJ June 61 2025 web - Flipbook - Page 43
Medicolegal Reporting: Key Principles
Common pitfalls in reporting include:
• Overstating the severity of findings based on
radiographs alone.
Medicolegal reporting of wrist fractures demands
clarity, consistency, and a structured approach. The
stakes are high: the report may determine compensation, inform settlement discussions, or serve as a
central piece of evidence in court.
• Failing to consider non-accident-related contributors to ongoing symptoms.
• Neglecting to address variability in patient outcomes
or psychological comorbidities.
Best practice elements of a medicolegal wrist
fracture report include:
1. Thorough documentation of the history: Including mechanism of injury, immediate symptoms, and
treatment timeline.
2. Detailed analysis of imaging: Initial, intra-treatment, and final radiographs should be reviewed to
assess alignment, healing, and any complications.
• Using overly technical language without explanation - clarity is critical.
Ultimately, a high-quality report is balanced,
independent, and clearly reasoned. It should assist the
court or instructing parties in understanding the injury’s relevance, consequences, and long-term implications - while staying strictly within the expert’s scope
of expertise.
3. Clear description of the injury and management:
Including whether the injury was intra-articular,
the surgical technique used, and any perioperative
complications.
Conclusion and Medicolegal Reflections
5. Analysis of causation: Distinguishing between
symptoms attributable to the index event and those
likely due to unrelated or degenerative causes.
Wrist fractures are common injuries, but their
medicolegal analysis is rarely straightforward. While
many patients make excellent recoveries, a significant
minority experience ongoing symptoms, complications, or dissatisfaction with their outcome. The challenge for the expert lies in differentiating expected
consequences of the injury from avoidable harm or
substandard care.
6. Prognosis and residual disability: Based on
evidence and clinical reasoning, with reference to
outcome studies where appropriate.
7. Consideration of the relevant legal test: For
example, the “but for” test in tort law or balance of
probabilities when discussing causation.
From a medicolegal standpoint, these injuries are
rarely “perfect” in terms of their recovery. The notion
of “perfect” must be understood in context - not every
patient will regain pre-injury function, and many will
experience residual stiffness, pain, altered wrist mechanics, or complications even with ideal management.
4. Objective clinical examination findings:
Documenting deformity, range of motion, tenderness,
sensory or motor deficits, and signs of CRPS.
Mr Ross Fawdington
Consultant Trauma & Orthopaedic Surgeon
MBChB, FRCS Ed (Tr&Orth), MFST Ed, MSc Hand Surg
I am a Consultant Trauma and Orthopaedic Surgeon working in a Major Trauma Centre that receives tertiary
referrals for civilian and military patients. My clinical practice involves both upper and lower limb surgery
managing complex trauma, malunions, nonunions, infection and metastatic bone disease.
My elective practice focusses on hand and wrist pathology and upper limb conditions. I have two fellowships
in Hand Surgery, and Lower Limb Complex Trauma Reconstruction.
I have a Masters Degree with merit in Hand Surgery and have passed the Cardiff University Bond Solon
(CUBS) Expert Witness Certificate.
I have been the QE hospital T&O department Clinical Service Lead and am a core member of the Metalwork
Review Group discussing complex cases that potentially need corrective revision surgery. I am currently the
Clinical Lead for Metastatic Bone Disease.
Contact: Vikki Hibbert, mobile: 07510 417479
Email: Vikki.Hibbert@HCAHealthcare.co.uk
Website: www.experthandsurgery.co.uk
Address: The Harborne Hospital - HCA, Mindelsohn Way, Birmingham, B15 2FQ
EXPERT WITNESS JOURNAL
41
JUNE 2025
