Case Vignettes

But He Didn’t Hurt His Ankle!

long leg cast

The plaintiff sustained a fracture involving the upper end of his shin bone.  It was managed successfully, it had united without difficulty and the expectation was that he would return to symptomatic normality.

His claim however centred upon his ipsilateral ankle.  He complained of pain, swelling and stiffness which interfered with his ambulatory capacity and compromised his future economic prospects as a labourer.  READ MORE


“You Can’t be Serious!”


The insurer was incredulous.  How is it that this upper shin fracture has given rise to such a debilitating problem with the ankle?

Well, the therapeutic regimen was of a non-operative nature and it included the application of a long leg cast for a four month period.  The cast was not well applied and the ankle was fixed in a downward position (plantar flexion) for that entire duration.  Secondary capsular contractures formed and inadequate attention was paid to the problem following removal of the cast by the physiotherapist.

At the end of an 18 month period, the ankle joint remained quite stiff and the capsular contractures appeared to be solid.

Whilst uncommon, this is a recognised sequel to the inappropriate positioning of the joint for a prolonged period without proper rehabilitation.  Although the ankle itself may not have been injured at the time, the sequence of events which has followed renders the ankle malady as being of a compensable nature.  The causative link is indirect but real.