Rachel broke her left clavicle when she was an infant. Unfortunately, it healed poorly and became a malunited pseudarthrosis. In 1997, aged 16, she was tired of the pain, swelling and unsightliness this caused her and she saw Mr C, specialist orthopaedic surgeon.
Mr C outlined the available treatment options, namely leaving things as they were or having surgery to correct the problem.
He took care to explain to Rachel and her mother that an operation might leave her with a large scar and that a metal plate would have to be inserted to fix the bone.
Rachel was advised the surgery was likely to improve her symptoms, but that Mr C could not guarantee that she would be symptom-free or entirely happy with the final appearance after surgery.
Rachel decided to have open reduction and internal fixation of her clavicular fracture; the surgery was uneventful. Mr C used subcuticular dexon sutures to minimise scarring. Postoperative x-rays showed the fracture had united satisfactorily with good alignment. During her follow up, Rachel complained of intermittent pain over her clavicle, but she had a full range of movement at the shoulder.
Eleven months after the original surgery, Mr C removed the plate to see if this would reduce the pain Rachel had been experiencing. At operation, the old fracture was seen to be firmly united and well-aligned. At her final review before discharge, six weeks after the revision surgery, Rachel was asymptomatic and appeared happy with the outcome.
Five years passed, then Rachel suddenly initiated legal proceedings against Mr C. She alleged he had failed to warn her of possible unsightly scarring, or that she would be left with a cosmetic appearance, shoulder dysfunction and pain worse than those caused by her original condition. She alleged this caused her life-impairing psychological problems for which she should be compensated.
We obtained an expert orthopaedic opinion, which was very supportive of Mr C’s counselling and treatment of Rachel. The expert had no criticism of the techniques Mr C had used and felt that he had done all he could to minimise scarring. It was felt that any scarring was inevitable, as good as could be expected, and not due to any deficiency on Mr C’s part. The expert was sceptical about the nature and severity of the symptoms of which the claimant complained.
We sought expert psychiatric opinion; he thought a large degree of the claimant’s unhappiness and lack of confidence, allegedly due to her scar, was actually due to recent adverse life events she had suffered.
According to expert cosmetic surgical advice, the scar was significant and noticeable, but not unusual for this area of skin.
There was no keloid formation and the cosmetic surgeon thought the scar’s appearance might improve over time, but that surgical intervention would be unlikely to help the situation. We rebutted the claim; it was discontinued shortly afterwards.
Where surgery is being considered as a way of relieving chronic symptoms or improving a cosmetic appearance, it is important to ensure that the patient is fully aware of the range of possible outcomes and their likelihood. These discussions should be documented in the notes, along with a note on the use of any leaflets, photographs or other materials.
We do our utmost to defend members from frivolous or unjustified claims, even where it incurs significant expenses. This is to protect the interests and reputation of members and to discourage unfounded claims.