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Failure to Diagnose Compartment Syndrome/Loss of Use of Dominant Arm - Osterman

Filed under Misdiagnosis, Surgical Errors

The Osterman Case

Trevor Osterman was 24 years old when he underwent surgery to remove hardware from his right arm on the ulnar bone that had been placed years earlier in a surgery to repair the flexor carpi ulnaris muscle and the extensor carpi ulnaris muscle. In the surgery to remove the hardware, the surgeon noted the difficulty he had in closing the fascia. Trevor was discharged home after the surgery.

At about 9:30 PM, the evening of the surgery, Trevor experienced excruciating pain in his right arm. He went to the emergency room of a local community hospital where his pain was recorded 10/10. The ER doctor placed a call to Trevor’s surgeon. He could not visually observe the right arm because of a cast that was placed after the surgery. The ER doctor described Trevor’s condition. Per his ER note, the ER doctor described contracted, rigid fingers of his right hand. The surgeon recommended ibuprofen with Vicodin and said that Trevor’s pain was likely due from muscle manipulation and muscle spasm. The surgeon said that these conditions were to be expected from the surgery. The surgeon said that Trevor would be seen in his office in three days.

Trevor made about four more calls to his surgeon’s office. The response to each of these calls was a message that Trevor did not have to be seen immediately. On his last call, Trevor was told to come to the office. That office visit resulted in the diagnosis of compartment syndrome for which Trevor underwent emergency surgery.

Compartment syndrome describes increased pressure within a muscle compartment of the arm or leg. It is most often due to injury, such as fracture, that causes bleeding in a muscle, which then causes increased pressure in the muscle. This pressure increase causes nerve damage due to decreased blood supply.

Common Signs and Symptoms: The “5 P’s” are oftentimes associated with compartment syndrome: pain, pallor (pale skin tone), paresthesia (numbness feeling), pulselessness (faint pulse) and paralysis (weakness with movements). Numbness, tingling, or pain may be present in the entire lower leg and foot.

A doctor may suspect compartment syndrome based on the type of injury, a person’s description of symptoms, and a physical exam. Sometimes, the diagnosis of compartment syndrome is clear from these findings.

In many cases, a definite diagnosis of compartment syndrome requires direct measurement of pressures inside the body compartment. To do this, a doctor can insert a needle into the area of suspected compartment syndrome while an attached pressure monitor records the pressure. A plastic catheter can also be inserted to monitor the compartment pressure continuously.

Once recognized, compartment syndrome requires emergency surgery to expose the affected muscle and nerves to oxygen. Compartment syndrome which is not timely treated will likely result in loss of use of the affected muscle and nerves.

Because of the late diagnosis of Trevor’s compartment syndrome, he lost total use of his right (his dominant) arm. Trevor sought the representation of Harry S. Cohen & Associates for a medical malpractice action against his surgeon and the hospital. On behalf of Trevor, we filed suit and took the deposition of the surgeon. The surgeon was remarkably candid in his deposition. He acknowledged that he should have recognized that Trevor either had compartment syndrome or was certainly at risk for compartment syndrome at the time he received the call from the community hospital emergency room. As for the four subsequent calls from Trevor reporting pain, the surgeon said that he had never received those calls; that the calls were taken by his office staff but never relayed to him. The surgeon testified that his office staff should have notified him of these phone messages.

We were able to achieve a multimillion dollar settlement for Trevor surprisingly early in the litigation.

At the time of his injury, Trevor was employed as a truck driver. His injury will preclude him from that type of work in the future. Trevor is using his settlement money to attend college. He plans on becoming an accountant.