Opinion ID: 2043003
Heading Depth: 1
Heading Rank: 3

Heading: roan eagle's injury

Text: Dr. Chris Wilkinson, an orthopedist, attended Roan Eagle and diagnosed the injury as a closed proximal femoral fracture which is basically an intertrochanteric subtrochanteric comminuted fracture. The femur, or thigh bone, transmits weight of a person's trunk from the hip to the lower extremities and is comprised of the femoral head, neck, two processes or prominences called the greater trochanter and lesser trochanter, and a shaft. The femoral head is smooth and globular, forming more than half a sphere, and fits into and articulates with the acetabulum, a cup-shaped formation of the hip bone, to form a ball-and-socket joint. The femur's neck lies between the femoral head and shaft. The greater trochanter is located laterally at the base of the femoral neck and slightly above the lesser trochanter on the nearly opposite side of the shaft. On June 27, Dr. Wilkinson surgically reduced the somewhat transverse or oblique fracture of the shaft in Roan Eagle's right femur, a fracture which was located just below the femoral neck between the trochanters. After aligning the femoral fragments, Dr. Wilkinson secured the reduction by laterally countersinking two cortical screws in the femur's shaft, one above and the other below the fracture. Over the cortical screws, Dr. Wilkinson laid a contoured six-hole metal plate against the femur, drilled six holes into the shaft, and inserted cortical screws through the plate into the shaft, with three screws above and three screws below the fracture. A 3æinch lag screw was then implanted into the femur's head and by a compression screw was tightened to extend through the femoral head and neck into the femur's shaft at the fracture site. Roan Eagle was then transferred to the Crawford hospital and eventually returned to his home. For the remainder of 1986, Roan Eagle made monthly trips to Chadron for postoperative checkups by Dr. Wilkinson. In the course of those visits, Dr. Wilkinson noted that Roan Eagle's pain persisted in the right hip, and fluoroscoped the hip to see if it was possible to see any position in which the leg [sic] screw protruded from the head into the joint. I could not tell on any angle or amount of rotation that the screw had protruded into the hip joint. Roan Eagle's pain continued virtually unchanged until December 1986 when Dr. Wilkinson, without further radiographs, rendered the assessment that Roan Eagle was doing well as far as I can tell, although Roan Eagle had not returned to work at that time. Since Roan Eagle's hip was apparently mending, Dr. Wilkinson expressed the opinion that it'll be a year before he is really back to normal and possibly as long as two years before he has his strength built up and can resume unlimited activities. Dr. Wilkinson recommended that Roan Eagle not lift anything and carry only light objects. On one of Roan Eagle's visits in the forepart of 1987, Dr. Wilkinson told Roan Eagle that he was pretty good and decided to leave the metal implant in Roan Eagle's femur, but suggested that Roan Eagle not do any heavy lifting. It was not until June 1988 that Roan Eagle returned to work for the State, this time as an operator of a power lawnmower, but, on account of pain from getting on and off the mower, was unable to continue this employment. His hip started hurting [him] more in the last part of 1988. At that point Roan Eagle found that he was unable to walk for any appreciable distance and that his hip pain was increasing, necessitating Roan Eagle's use of a wheelchair or cane for locomotion. Roan Eagle filed his action in the Nebraska Workers' Compensation Court on June 26, 1989. Roan Eagle then returned to Dr. Wilkinson on July 25, 1989. Dr. Wilkinson reviewed Roan Eagle's orthopedic history and noted that Roan Eagle had been unable to return to work. Also, Dr. Wilkinson concluded that, throughout his previous treatment of Roan Eagle, [a]t no point ... could the lag screw head be demonstrated to impinge onto the joint. During his further examination of Roan Eagle on the July 1989 visit, Dr. Wilkinson observed some motion about the lag screw, but was unable to determine the exact extent of the lag screw's movement in the femoral head. At that point, Dr. Wilkinson became disturbed on account of Roan Eagle's persistent pain and was concerned about penetration of the joint by the lag screw. In view of limited suitable radiographic equipment, Dr. Wilkinson suggested that Roan Eagle travel to Scottsbluff for a CT [computerized tomography] scan of the hip to ascertain the extent of hip damage from the lag screw. Subsequently, on September 28, 1989, Roan Eagle visited a Scottsbluff orthopedist, but when Roan Eagle was unable to provide an advance payment of $1,500 for orthopedic services, he received no further medical attention. When the accident happened, Roan Eagle was a 53-year-old manual laborer with a 10th grade education. Although he applied for reemployment with the State, he was turned down. According to Dr. Wilkinson's evaluation on July 25, 1989, Roan Eagle sustained a 13% impairment of the whole person, a rating which was subject to revision depending on a further determination whether to retain the metallic implants, especially the lag screw which protruded into Roan Eagle's hip joint. Also, Dr. Wilkinson expressed that Roan Eagle's impairment rating of course is not a disability rating as a patient with a small impairment may have a large disability, depending on his education and pain tolerance and the type of work that he does. Before the rehearing on April 17, 1990, the State paid most of Roan Eagle's medical expenses and some benefits for Roan Eagle's temporary total disability. The State's last payment for Roan Eagle was made to the Crawford hospital in March 1987.