Opinion ID: 1773140
Heading Depth: 1
Heading Rank: 9

Heading: the july films

Text: As to the July 9, x-rays films, Dr. Robertson testified he found three separate fragments of bone around the metacarpal-phalangeal joint. 1. A fragment of bone overlying the distal end of the first metacarpal bone, on the ulnar side. 2. A fragment of bone off the dorsal (back) surface of the phalanx next to the metacarpal bone. 3. A fragment on the front of the proximal phalanx adjacent to the joint. The significance of these fragments to him was that they evidenced a tearing away of the ligaments at the joint. He found it very probable from the x-rays that all the ligaments around the joint had been torn. Also, according to Dr. Robertson, the November films showed the same three avulsion fractures. Dr. Robertson prepared an illustrated colored drawing of the area involved, and how it was x-rayed, but this was not made an exhibit. Also, while Dr. Robertson stated he saw three bone fragments and pointed to them on the films, it is by no means clear the jury saw them. Manifestly, they were minute. He stated they were difficult to see by an untrained eye. He attempted to illustrate their position by an enlarged view he had drawn on a blackboard, but on objection he was not permitted to testify from the blackboard. It is unfortunate these locations, and these illustrations are not part of the record. Any communication is flawed to the degree that the hearer does not know precisely what the speaker is talking about. While Dr. Robertson was quite positive there was tearing of the ligaments around the joint by viewing the July 9 films and noting three small fractures, what made him certain of a tearing of the ligaments was the dislocation of the joint shown on the November films. What did all the remaining doctors testify? Dr. Clayton found no avulsion fracture was discernible on the July x-ray films. He did find a white streak on one of the films which he identified as an artifact. This did not appear on any of the other July films, or any of the November films. In November the same positions of the hand were x-rayed as in July. Dr. Clayton said in distinguishing an artifact from pathology of the anatomy, he considered whether the thing observed appeared on any other films, was the margin fuzzy, or did it resemble a fracture which had sharp edges. To emphasize his contention of the absence of any avulsion fractures or bone fragments appearing on the July films, Dr. Clayton had enlargements or blowups of the injured area on each of the July films, which were made exhibits to his testimony. No attempt was made in cross-examination to point out any of the alleged fragments or fractures which Dr. Robertson stated were shown on the films. Dr. Meyer, the plaintiff's own witness, testified he could find no evidence of fracture of any kind on any of the July films. He observed a density which he thought was an artifact. Dr. Meyer saw no fractures when he performed surgery. Dr. Packer testified he saw no evidence of fracture in any of the July films. He observed a density such as testified to by Dr. Clayton, but said it was an artifact. [5] This anomaly was not discernible on either of the remaining July films, or any of the November films. He could not see any defect in the phalanx or metacarpal, the bones from which such a fragment would have come. Dr. Caden found no evidence of any kind of fracture on any of the July films or their blowups. He also found a density he called an artifact on one of the July films, which did not appear on any of the November films. He said a fracture of a bone was like a glass when it shatters, the edges of the sliver as well as the bone from which it has been torn were sharp. Also, a bone chip of the size of the density he observed would have trabecule (fibers) which would show up as lines on the x-ray film. This anomaly did not. Also, it was in the wrong place to have been a fracture from this injury. The absence of the anomaly on any of the remaining July films further indicated to him it was an artifact. Dr. Carter as a witness testified no evidence of a fracture could be seen on any of the July films, and except for the swelling they appeared normal. He, too, mentioned a density next to the head of the metacarpal. He was of the opinion it was an artifact for the same reasons given by the other physicians, with the additional reason there was no dislocation shown on the July films. On cross-examination Dr. Carter conceded he had some time previously examined the July films in his office and had written a report stating that on one of them he saw a density at the metacarpal head 1 x 2 millimeters (about 1/12 x 1/25 of an inch) in size which could represent a small cortical evulsion, and he recommended the patient be checked again in seven to ten days. As a witness, however, and having again reviewed all x-rays, including the blowups, he agreed with the July 9 x-ray report of Dr. Clayton. He reiterated his testimony that in his opinion the July films showed no fractures, and except for the swelling of the hand, appeared normal. As a witness he had the benefit of the November films for comparison as well as the blowups. As can thus be noted, at least two of the bone fragments Dr. Robertson testified he perceived were not seen by any other physician. But what about a third bone fragment? Was whatever he saw the same anomaly observed by the other physicians? It appears unlikely because what they saw was not apparent on the November films, and what he claimed to have seen was, according to him, apparent on the November films as well. Drs. Clayton, Carter, Packer, Caden and Meyer all observed an anomaly on one of the July films. All five of these physicians testified this anomaly did not appear on the November films, and all concluded it was an artifact. While it appears unlikely that any of the three anomalies noted by Dr. Robertson as bone fragments could be observed by any of the remaining physicians, even it were conceded that one out of the three things he saw was what the other doctors saw, it is clear all the remaining five concluded it was an artifact, not bone.