In Choosing an Orthopedic Surgery Expert Witness, Burton Bentley II, M.D FAAEM, writes:
Orthopedic surgery (commonly spelled “Orthopaedic” in academia) is a field of surgery dealing with the surgical treatment of disease and injury of the musculoskeletal system. Orthopedic surgeons are licensed physicians who complete a five year residency program in orthopedic surgery often followed by subspecialization in a specific branch of orthopedic surgery. Common subspecialty areas include Hand Surgery, Total Joint Reconstruction (i.e. arthroplasty), Pediatric Orthopedics, Foot and Ankle Surgery, Spine Surgery, Sports Medicine, and Trauma. Board certification in Orthopedic Surgery is conferred by the American Board of Orthopaedic Surgery, a section of the American Board of Medical Specialties (ABMS). Physicians who enter the field of orthopedics via an osteopathic pathway (D.O. rather than M.D.) are eligible for Board Certification under the American Osteopathic Board of Orthopedic Surgery.
Orthopedic surgeons diagnose, image, medically treat, and surgically correct a broad range of musculoskeletal conditions. Common procedures in orthopedic surgery include arthroscopic surgery upon the knee and shoulder, joint replacement surgery (predominantly upon the hip and knee), spine surgery, and carpal tunnel release. The foundation of orthopedics, however, is the stabilization and treatment of various fractures. Fractures may be treated non-operatively (closed reduction) or operatively (open reduction). Some fractures may require internal hardware (internal fixation) while others require external hardware (external fixation) or no hardware at all. The most common fracture sites include the hip (e.g. femoral neck), ankle, tibia, wrist (radius and/or ulna), humerus, and clavicle. Other acute conditions in orthopedic surgery include compartment syndrome and the management of complex bone and joint infections. Depending on the complexity of the procedure, orthopedic interventions may be performed in the office, in an outpatient surgical facility (ambulatory surgery center), or in a hospital-based operating room.
Orthopedic surgery expert witnesses are critical in several important aspects of orthopedic litigation including standard of care, causation, and harm. Orthopedic surgery expert witnesses may also determine the etiology, extent, and prognosis of various musculoskeletal conditions, including complications caused by trauma or alleged medical negligence. For example, an orthopedic surgery expert witness may look at the circumstances surrounding a work-related injury in order to determine whether, to a reasonable degree of medical probability, a person’s injury was acute rather than related to a preexisting condition. The same expert might also determine the prognosis of the person’s condition, such as the disability rating or need for future medical care. Orthopedic surgery experts are also commonly called upon to perform Independent Medical Examinations (IME). An IME is an indispensable tool for objectively assessing a person’s physical condition. A thorough and impartial IME allows one to make critical determinations regarding the existence, origin, extent, and prognosis of a specific orthopedic condition.
Litigation against orthopedic surgeons typically stems from poor surgical outcomes resulting in pain or functional loss. This may occur as a result of surgical technique, infection, or other complicating factors. Delayed treatment of “compartment syndrome” (a limb-threatening elevation in extremity pressure) is another area of risk for practicing orthopedists. Since orthopedic surgeons employ a range of highly specialized surgical devices, orthopedic expert witnesses are often called to testify for both plaintiff and defense in product liability cases. Such litigation is increasingly common with many cases gaining national notoriety as class action lawsuits.
Given the complexity and expense of orthopedic surgery litigation, it is imperative to carefully choose an orthopedic surgery expert witness. A top-tier orthopedic surgery expert witness will have Board Certification, full-time clinical practice, and a professorial appointment at a major university medical center. Beyond those requisite steps, be sure to interview your expert witness candidate to assure impartiality, freedom from conflict, and communication skills. The expert should also agree to remain involved with the case throughout all phases of litigation. When all criteria are met, you will have minimized your risk and set the best course for investigating your orthopedic surgery case.
Dr. Bentley is the President and CEO of ELITE MEDICAL EXPERTS. In his full-time clinical practice he is an attending Emergency Physician at Northwest Medical Center in Tucson, Arizona. With over twenty years of clinical experience, he has provided emergency care to over 60,000 patients. He is also the principal physician of Emergency Medicine Litigation Analysts, Inc., where Dr. Bentley has consulted upon countless claims of potential medical negligence for both plaintiff and defense.