CASE VIGNETTE – JUNE 2018

The Scars Were All On The Inside

Catherine was a 45 year old mother of three young children, happily married and working in a full-time capacity as a primary school teacher in a provincial centre not far from Brisbane.  She was driving the family’s Mitsubishi Pajero on a country road about 80km south of Brisbane.  She was in a 100km/hour zone.  She was approaching a T intersection.  An oncoming Falcon sedan, being driven by a 64 year old lady, was stationary on the highway, waiting to turn right at that T intersection.  Catherine was proceeding straight through.  Unfortunately, as she approached the Falcon sedan, it was struck from the rear by a following truck.  The forces applied to the Falcon sedan pushed it forwards and to the right side, into the path of travel of Catherine’s Mitsubishi Pajero.  The lady driving the Falcon sedan was fatally injured.  Such was the physical carnage that it is probable that her life was extinguished instantly.

Catherine survived but she sustained a plethora of orthopaedic injuries.  Both of her collar bones (clavicles) were fractured, she had seven rib fractures on the right chest wall and nine rib fractures on the left chest wall.  The central sternal segment was “floating”.  Both lungs were punctured, there was a massive haematoma around her heart and just like Steve Irwin, she was suffering with so-called cardiac tamponade.  This is a situation that occurs when blood is being pumped out of the heart through a rent in its wall.  The surrounding pericardium (a non-expansile sheath) is intact.  The pressure that builds up inside this pericardial sac is such that it compresses the heart and gradually but inexorably stops the heart pumping.  Untreated, death is inevitable.

Catherine was retrieved promptly, transported without delay and subjected to immediate open heart surgery.  She survived.

Both clavicular fractures united, as did the chest wall injuries.  Most clavicular fractures heal without residual sequelae and it is very uncommon for rib fractures to give rise to long-term pain.  Both of her lungs reinflated and apart from the longitudinal scar down her anterior chest wall, there was very little visible evidence that the accident had occurred.

I met Catherine six years following the date of the accident.  From an orthopaedic perspective, apart from the scar there was very little to see.  Both shoulders were functioning satisfactorily, the claviculae were pain-free and her chest wall also expanded normally.  The AMA 5 Guides gave her a 0% impairment of whole person function in purely orthopaedic terms.

Unfortunately, Catherine was never the same again.  Despite the lack of any form of contributory negligence, to that day she felt responsible for this lady’s death.  Her inconsolable anguish wreaked irreversible damage upon her marriage, her family and her friendship group.  She did not return to work, she isolated herself from her previously close community and clearly expressed the view that she felt her life was not worth living.  It is one of the most tragic cases I have seen.

On this occasion, there was no orthopaedic mileage with her claim.  All the scars were “internal”.