Expert Opinion on Orthopaedic Injuries - Yared Strachur (PDF)

10 September 2024 Ms Cassie Hassan-MacEwan Solicitor Stopp and MacCrash LLP 35 Thistle Street Edinburgh EH2 1DY Our Ref: 00523 - STRA Direct e-mail: [email protected] Dear Ms Hassan-MacEwan, Claim by Yared Strachur Date of Accident: 30th July 2024 I refer to your le...

10 September 2024 Ms Cassie Hassan-MacEwan Solicitor Stopp and MacCrash LLP 35 Thistle Street Edinburgh EH2 1DY Our Ref: 00523 - STRA Direct e-mail: [email protected] Dear Ms Hassan-MacEwan, Claim by Yared Strachur Date of Accident: 30th July 2024 I refer to your letter of instruction and papers. I attach herewith my expert report. My invoice for this opinion is £1,500 for my time plus VAT, plus £200 for urgency and £1,000 for travel time, travel costs and consulting rooms local to your client, being a total of £3,000.00, payable in full within 21 days. Thank you for your instructions. Yours sincerely, Professor Katharine Campbell Consultant Orthopaedic Surgeon Consulting rooms 160-162 Union Street Aberdeen AB10 1QT Page 1 of 11 Independent Medico-legal opinion – Consultant Orthopaedic Surgeon Professor Katharine Campbell Medical report – Yared Strachur 1. My Career 1.1. I have been a Consultant Orthopaedic Surgeon at the King James NHS Infirmary in Aberdeen for 32 years. My speciality training was in knees and hips and I have performed over a thousand knee replacements throughout my career. I contribute data on my success rates to the Scottish Arthroscopy Project. I have been providing medico-legal opinions for 15 years. I work exclusively for claimants and pursuers. I have provided over 500 medico-legal opinions in personal injuries actions. I have appeared in court twenty-five times, 18 in the Sheriff Court and 7 in the Court of Session. I am an Honorary Professor at the University of Aberdeen and I teach at the medical school. I have published around 120 articles and papers and regularly appear at conferences. I live in Aberdeenshire. 2. My Instructions 2.1. I am instructed by Ms Cassie Hassan-MacEwan, Solicitor, acting for Mr Yared Strachur to give my independent opinion on causation and condition and prognosis in relation to any orthopaedic injuries suffered by Mr Strachur. I am instructed to examine Mr Strachur and review his medical records in order to provide my opinion on the balance of probabilities. I am invited to make reference to any learned articles or other relevant authorities should I so choose. 2.2. My opinion is given on the strength of my expertise in orthopaedic surgery which I set out above under paragraph 1. 2 of 11 Independent Medico-legal opinion – Consultant Orthopaedic Surgeon Professor Katharine Campbell 2.3. My opinion is independent of those who have instructed me and I owe duties in this respect only to the court. I will uphold my duties to the court in providing this opinion and offer to attend court to speak to my expert opinion. 2.4. I have been provided with the following papers to review: 2.4.1. Precognition of Mr Yared Strachur 2.4.2. Hospital Records of Mr Yared Strachur from 30 July 2024 onwards 2.4.3. Prospective invoices for private physiotherapy and counselling, and for knee replacement surgery and hydrocortisone injections 3 of 11 Independent Medico-legal opinion – Consultant Orthopaedic Surgeon Professor Katharine Campbell 3. Review of medical records 3.1. I have reviewed the accident and emergency notes, theatre notes, plastic surgery department records and orthopaedic records. I note that Mr Strachur was taken into hospital following a pedestrian versus bicycle collision on the cycle lane on Leith Walk after Mr Strachur stepped out on a green man and collided with a passing bicycle. Mr Strachur was struck on the left side and landed on the right. He complained of left knee and left elbow pain and suffered a very serious injury to the distal ends of little and ring fingers of this right hand. Thanks to the swift and expert surgical expertise of his plastic surgeon Ms Nadeem, his fingers were saved, and skin grafts were provided. He seems to also have suffered soft tissue scrapes and bruises from the collision. I note from his precognition and the records that he may have lost consciousness which may have been from shock or query head injury. Nothing turns on that observation. I note that after a reasonable period in hospital under the care of the plastic surgery and orthopaedic departments, he was discharged into the care of local nursing and physiotherapy departments. I note anticipatory estimates and invoices as regards knee symptoms from a private provider. 3.2. I have requested sight of any GP records and a copy of any MRI scans and X-rays but have been informed that those are not available. My opinion is based on the information available to me at the time my opinion is given. I will require to update my opinion if any additional records are made available. 4 of 11 Independent Medico-legal opinion – Consultant Orthopaedic Surgeon Professor Katharine Campbell 4. Examination 4.1. I met with Mr Yared Strachur at consulting rooms on George Street, Edinburgh on 9 September 2024. I confirmed with him as soon as we met that he was born male, identifies as male and prefers to use, “he” and “him”. He was born on 23 July 1998 which makes him 26 years old. I asked to see a copy of his photo ID to verify his identity. He confirmed verbally that his home address was flat 3/3 at 1 Brunton Place, Edinburgh EH7 5EG. 4.2. Mr Strachur appeared in good spirits, speaking quickly and with a pleasing affect. He limped as he walked into the room, giving the impression that his left leg was injured. I took a medical history from him which largely accorded with what I had read in his medical records. 4.3. He was quite dramatic in his description of the incident, but I understand he is a performer at the Edinburgh Festival so this did not surprise me. He said that the bicycle had swerved towards him and hit him after he had taken three clear steps towards the road crossing at the top of Leith Walk. He accepted that he smokes and drinks but refused to estimate his consumption of either. I will assume an average consumption for a man of his age and occupation. 4.4. He spoke at length about the negative impact the incident had had upon his intended Festival run. He explained the monetary cost to him of this to the penny. He ran through his set list and began signing one of the songs he was to perform, even though I told him he did not need to do so. 4.5. I examined Mr Strachur’s left knee and left elbow. I was unable to examine his right fingers as these had been dressed only an hour before and I did not see that my examination was worth introducing an infection risk. Mr Strachur explained he had been very careful with his hand and it had suffered no untoward incidents or injury after the incident in question. It was healing nicely he said, and I took him at his word as this was consistent with the medical records. 5 of 11 Independent Medico-legal opinion – Consultant Orthopaedic Surgeon Professor Katharine Campbell 4.6. Mr Strachur sat on the examination bed having taken off his trousers at my request. With his legs hanging off the edge of the bed, I examined his knees, moved both knees, compared the musculature on both legs and took his reflexes in both knees. I asked him to explain when it was painful. He described an ongoing aching in his left knee. He denied any such pain before the incident. He had inexplicable pain on reflexes being tested in his left knee. I noted that the musculature in his left calf was much less well developed than in his right. His left quadraceps was also less well developed than his right. Mr Strachur explained this was all new pain. He described how difficult it was for him to climb the stairs to his top floor flat. The only sporting activity he was able to do was lawn bowls. He had to sit when at home as walking across the floor caused him pain. He described how the surgeon at the hospital had recommended a knee replacement and he thought this was an excellent idea. He made reference to the invoices which have been given to me in my papers and knew the value of the invoices. He expressed his expectation that his claim would result in payment of these invoices. 4.7. Mr Strachur’s left elbow was nearly painless on examination. His musculature for left and right elbows was largely the same. However, he did present with a sharp pain on palpation of the left biceps. He explained that he had not noticed this before today. 6 of 11 Independent Medico-legal opinion – Consultant Orthopaedic Surgeon Professor Katharine Campbell 5. Opinion on Medical Causation 5.1. In my opinion, Mr Strachur suffered the following injuries as a result of the vehicle colliding with him while he was walking: 5.1.1. degloving injury to his distal little and ring fingers 5.1.2. left knee injury 5.1.3. left elbow injury 5.1.4. cuts and bruises to limbs, body and legs, which were not examined but documented in medical records 5.2. Medical Causation is established on balance of probabilities. 7 of 11 Independent Medico-legal opinion – Consultant Orthopaedic Surgeon Professor Katharine Campbell 6. Opinion on condition and prognosis 6.1. I am instructed by Ms Cassie Hassan-MacEwan, Solicitor, acting for Mr Yared Strachur to give my independent opinion on causation and condition and prognosis in relation to any orthopaedic injuries suffered by Mr Strachur. I have examined Mr Strachur and reviewed his medical records in order to provide my opinion on the balance of probabilities. I find no need to make no reference to any learned articles or other relevant authorities. 6.2. My opinion is given on the strength of my expertise in orthopaedic surgery which I set out above under paragraph 1. 6.3. My opinion is that Mr Strachur has suffered an exacerbation of pre-existing degenerative changes in his left knee as a result of the incident. The symptoms he presently suffers would have come on in around five years but for the incident, and will come and go now for the remainder of his life on balance. There is a 25% chance that the symptoms may resolve entirely for another ten years with appropriate physiotherapy. In my opinion, Mr Strachur would have needed two knee replacements over the course of his lifetime but for the incident. My opinion is that he may now require an additional knee replacement as a result of his injuries as described to me. I give his chances of needing an additional knee replacement at 60%. He would have required his first left knee replacement on balance in around 30 years but for the incident. He will now require his first left knee replacement on balance in around 10-15 years as a result of the injuries caused by the accident. While previously he would have been able to cope with two partial knee replacements in his lifetime, it is likely now that he will require a third knee replacement and that third replacement will be a total knee reaplcement. 8 of 11 Independent Medico-legal opinion – Consultant Orthopaedic Surgeon Professor Katharine Campbell 6.4. My opinion is that Mr Strachur may find relief from any ongoing pain by hydrocortisone injections. He should seek assessment from a specialist knee surgeon who can take an MRI, MR Arthrogram and CT scan of his knee to best recommend appropriate frequency of computer guided injection into the joint. I would hazard a guess at no more than 3 per year will be needed, and only if the initial injection does not resolve the pain. I would recommend injections only if physiotherapy exercises and good healthy living does not sufficiently resolve symptoms on their own. 6.5. I recommend that Mr Strachur engages with an intensive physiotherapy course in the first instance to strengthen his muscles in his left leg -five sessions a week for 10 weeks. The muscle wastage I observed is consistent with this being a pre-existing exacerbation. With proper engagement with physiotherapy, Mr Strathur’s pain may be resolved. I note that Mr Strachur has a physiotherapy referral from the NHS and a quote for private physiotherapy. I make no comment on whether or not the invoice is a reasonable charge for those proposed services. One would assume Mr Strachur will take advantage of the NHS physiotherapy as a taxpayer. In the meantime, I recommend over the counter anti- inflammatory medication and paracetamol for pain. Mr Strachur should continue regular exercise. Climbing the stairs to his top floor flat twice a day should be sufficient for the moment, as I believe he is presently doing, along with the physiotherapy exercises. I would encourage him to continue to lawn bowl as that is an excellent light exercise to keep him active while he recovers. He should avoid using his right hand until the skin graft has settled. 9 of 11 Independent Medico-legal opinion – Consultant Orthopaedic Surgeon Professor Katharine Campbell 6.6. My opinion is that Mr Strachur has suffered a complete or significant tear of his left biceps. I understand this has yet to be diagnosed. That is a reasonable thing to happen, since attention was on the possibility of a bony injury. He will require to be assessed by MRi scan to ascertain the extent of the tear. Hopefully the tear is only partial and will not require surgical repair, assuming so, it will heal in 6-8 weeks if he does not smoke and takes no alcohol. If he smoked, it will take an additional 4 weeks to heal in my experience. If he drinks alcohol regularly, it will take another 1 week to heal. 6.7. I make no comment upon Mr Strachur’s skin graft and finger injuries. In general terms, such injuries are notoriously difficult to predict. I would anticipate given how positive the reports are at this stage from his hospital staff, and assuming that he continues to engage with all medical advice he is given, that his fingers will heal and be able to be used for his guitar in no less than 6 months, but no more than 12 months. I note that Ms Nadeem took care to repair the fingers in the knowledge that the repaired hand was going to be used by a professional guitar player. I have every confidence in her abilities. 6.8. At present, Mr Strachur is not fit for his previous employment of working at a newsagent. He cannot stand for a lengthy period, he will not easily be able to use his left arm or right hand. I estimate he will remain unfit for work for 6 months. After that, he will be fully fit to return to his previous employment to the extent he was working before his incident. 6.9. Fitness for playing his guitar is all down to him being careful and allowing his fingers to properly heal. Given how important playing the guitar is to him, I am confident he will be able to return to playing the guitar in around 9 months. I am sorry that he was not able to make his run at the Festival. I would anticipate he will be fit to play next year on balance, though I make no guarantee. 10 of 11 Independent Medico-legal opinion – Consultant Orthopaedic Surgeon Professor Katharine Campbell 6.10. Mr Strachur narrates getting home deliveries for food, and seeking pre-prepared foods. He recounts that his girlfriend might be willing to assist him with cleaning and other chores which he says he would need help with for 25 hours a week. I make no comment on his estimate of the number of hours needed. I would estimate he will only need help around the home for 6 months. He will be able to prepare his own food in 2-3 months but may wish to hang back from that for 6 months to avoid disrupting the healing of his skin graft. 6.11. Mr Strachur will not need any DIY or other more long-term assistance. As a young man with a good dextrous mind, I anticipate he will get by without any assistance. Signed: Professor Katharine Campbell 10 September 2024 11 of 11