A private neurosurgeon faces questions on consent, following a lumbar microdiscectomy sciatica and back pain

Three-year-old Matthew was brought to the local A&E department by his mum, Mrs U. She told Dr M, the attending doctor, that Matthew had fallen from a chair three days ago and, although he seemed unharmed at the time, he was now refusing to walk.

Mr A, an orthopaedic surgeon, was approached by a claimant’s solicitors to provide an expert report on behalf of their client.

Forty-four-year-old Ms M presented to her GP with pain and swelling of her right knee. She had experienced similar symptoms three years earlier whilst pregnant but had not undergone any investigations at the time

Ms E, a 29-year-old mother, had suffered with ongoing low back pain since the birth of her second child two years ago, which had failed to improve with physiotherapy. She was assessed in orthopaedic outpatients and diagnosed with an L5 disc prolapse and listed for microdiscectomy.

Ms C, a 42-year-old risk manager, fell from her horse whilst out riding. At the time of the fall she felt her left knee twist, as her left foot had been caught in the stirrup.

Complaints in health and social care: standards and guidelines for resolution and learning (2009) aims to provide a simple, consistent approach for staff who handle complaints, and for patients who raise complaints across all health and social care services.

Mr G was a 52-year-old school headmaster. His lifelong enjoyment of sports was becoming more difficult due to increasing pain from his left knee, although there was no injury or trauma to account for it

Mrs P was a 42-year-old housewife who lived with her husband, daughter and their first grandchild. She had suffered with chronic lower back pain for many years, which was helped by regular paracetamol.

Forty-seven-year old shop assistant Mr U had noticed a persistent pain in his heel for several months, which deteriorated suddenly whilst playing his weekly game of squash. It took him two weeks before he attended his local Emergency Department, where he was x-rayed and diagnosed with a bony spur on his calcaneus. He was advised to rest and to follow-up with his own GP if it did not resolve.

Six-year-old FM underwent a left Salter’s osteotomy to treat the developmental dysplasia of his hip. Mr R, consultant orthopaedic surgeon, performed the procedure. Prior to it, he discussed the risks and benefits of this operation with FM’s parents and recorded it all in the clinical notes.

Twenty-year-old Miss D was referred to orthopaedic consultant Mr A for assessment of an old clavicle fracture. Two years previously, Miss D had sustained a clavicle fracture after falling off her bike. This injury was treated in a different hospital in a conservative way, using a collar and cuff sling. In the early follow-up period, she moved to her current address and she was lost to further review.

Fifty-five-year-old lorry driver Mr Q was involved in a road traffic accident, sustaining severe injuries to both legs. He was taken to the local hospital where, following initial assessment and stabilisation by the emergency medicine team, he was referred to the orthopaedic department.

Mr A, an office administrator in his 40s, was referred by an out-of-hours GP to the orthopaedic on-call team at the local district general hospital (DGH). Mr A had previously worked as a mechanic, but had been forced to change career because of a long-standing back problem, for which he had an L4/L5 microdiscectomy performed five years earlier.

Mr C, a 45-year-old PE teacher, attended the outpatient clinic to see Mr V, consultant orthopaedic surgeon. Mr C was also a keen marathon runner, but due to an increasingly painful right hip he had found running more difficult. X-rays confirmed advanced degenerative changes on his right hip joint.

Ms D, a 41-year-old secretary, experienced worsening pain and paraesthesia in her right hand over the course of a year. Her GP referred her to a consultant orthopaedic surgeon, Mr S, for surgical treatment of her carpal tunnel syndrome.

Mrs A, a 31-year-old dental nurse, sustained a complex fracture of her dominant right distal humerus after falling from her bike. She attended the local A&E Department, where other injuries were excluded, and she was admitted to the orthopaedic unit. She was reviewed by the orthopaedic team on call.

When Mrs C, a keen golfer in her early forties, began to experience constant pain in her lower back, she consulted a GP at her local surgery. Dr P took a history of slow onset of pain with restricted mobility. He did not examine her, but prescribed an NSAID and advised Mrs C to return in two weeks if there was no improvement.

Mr E had developed a bad back and a friend had recommended that he see Mr G, an orthopaedic specialist. Mr E made an appointment to see Mr G at a private hospital in the UK without asking his GP to refer him. Mr G thought that Mr E had a prolapsed lumbar disc, which he treated with epidural and facet-joint injections. An MRI scan confirmed a small left-sided paracentral disc prolapse, pressing on the L3/4 nerve root.

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 U, a 50-year-old dentist, had suffered from symptoms of cervical myelopathy – due to spinal canal stenosis and intervertebral disc protrusion – for five years. The diagnosis had been confirmed by magnetic resonance imaging (MRI).