Cases & News
Here are just some of the cases for which Dr. Graboff has provided Orthopedic Expert opinion and testimony. These are representative Personal Injury and Medical Malpractice cases for which Dr. Graboff was retained and qualified as the Orthopedic Expert Witness.
"Wrongful Death from Deep Vein Thrombosis/Pulmonary Embolism"
A 42-year-old morbidly obese policeman slips and falls on the ice while descending stairs, causing a severe hyperflexion injury to his knee. He suffers immediate severe pain in the right knee, and could hear as well as feel a loud popping. He tried to walk and had significant difficulty ambulating prompting an urgent visit to the local emergency department. After emergency evaluation, it was felt that he suffered a severe sprain to the right knee and he was placed into a knee immobilizer and crutches and advised to follow up with an orthopaedic surgeon.
Approximately three weeks later, he was seen by an orthopaedic surgeon who on clinical examination immediately diagnosed a complete rupture of the quadriceps tendon at the insertion to the patella of the knee and expressed concern as to why this had not been treated sooner. Within four days, he took the patient to surgery and repaired the acutely ruptured quadriceps tendon, placing him in a long leg cast with the leg in extension, nonweightbearing and continued him on crutches. After discharge from the hospital, he was seen in followup three days later where the cast was not removed. However, it was felt that the patient was doing well.
Three days after that, however, this individual was found unconscious and down on the floor in his bathroom in full cardiac arrest. He was pronounced dead at the local emergency room and the medical examiner/coroner report identifies the cause of death as acute deep vein thrombosis with resultant massive pulmonary embolism and blunt knee trauma.
The issues in this case include: the misdiagnosis in the first emergency department visit where he was diagnosed as having a knee sprain only, the lack of urgent orthopaedic consultation at the time of the first emergency department visit, the failure to recognize the high risk of this individual developing deep vein thrombosis and pulmonary embolism due to his lack of weightbearing, immobilization, blunt knee trauma, lack of knee movement, delay in definitive surgical treatment, morbid obesity, and failure to provide deep vein thrombosis prophylaxis.
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"Motor Vehicle Accident with Preexisting Degenerative Spine Disease"
A 62-year-old hospital food service worker that has been permanently disabled for 10 years due to chronic low back pain syndrome as a result of advanced multilevel degenerative disk and joint disease/spondylosis, and who has been participating actively in chronic pain management treatment, is the seat belted driver involved in a motor vehicle accident.
At the scene of the accident, the patient is able to exit the vehicle freely and ambulate and no emergency medical care or treatment is required. After driving the same vehicle home, this patient does not seek out any medical care or treatment for the next five days but then sees the same treating chiropractor who has been treating the chronic condition for many years and identifies new complaints of back pain as a result of the motor vehicle accident.
The patient then embarks on an acute course of diagnostic evaluation including MRI, CT scans, electrodiagnostic studies, neurologic consultations and extensive chiropractic treatment based on this motor vehicle accident.
The issues in this case are: what if any injuries were truly sustained as a result of the accident as compared to the preexistent disease process and the ongoing need for medical care and treatment in the absence of this motor vehicle accident; were there any new true structural or anatomical injuries that required care and treatment; in comparing the subjective complaints and objective findings prior to and subsequent to this motor vehicle accident, was there any justifiable increase or change that warranted acute medical care and treatment?
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"Failed Total Hip Replacement with Post-op Nerve Injury"
A 58-year-old male heavy equipment operator underwent a primary total hip replacement for the diagnosis of advanced degenerative joint disease and arthritis. Rather immediately postop, the patient began developing a sense of instability of the right hip and lower extremity with a feeling of popping and clicking and persistent pain that began within days postoperatively and persisted in the postoperative rehabilitation.
On repeated evaluations by his physician, he was told that this was normal and to be expected. However, after months of pain and dysfunction, he sought a second opinion. The second opinion orthopaedic surgeon found that the primary hip replacement was placed in a negligent fashion and was the direct cause of the instability, chronic pain, and dysfunction. This prompted a rather premature revision hip replacement.
In the recovery room, immediately after the revision hip replacement, the patient was noted to have a complete dense ipsilateral peroneal nerve palsy and drop foot. Electrodiagnostically, this ultimately was found to be due to extrinsic pressure of the peroneal nerve at the level of the fibula head that occurred during the surgery.
The issues in this case are: technical negligence in the primary hip replacement surgery causing premature failure and need for revision hip surgery, and the permanent peroneal nerve damage caused by extrinsic pressure on the knee during the revision hip replacement surgery.
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"Blunt Knee Trauma and Meniscal Tear"
A 38-year-old railroad worker, while descending a boxcar ladder, fell from the bottom rung onto the ballast bluntly striking the anterior portion of his knee in a nonweightbearing position and with no twisting forces. He was able to stand up by himself and continue working the rest of his shift. The next day, he filed an injury report and sought medical treatment for his knee injury. He was evaluated and diagnosed as having a knee contusion and treated appropriately for that injury.
Four months later, after his claim became litigated, he was seen by an orthopaedic surgeon and diagnosed as having a torn meniscal cartilage in the knee necessitating arthroscopic meniscal surgery and extensive rehabilitation. He was ultimately deemed unable to return to his usual and customary job and permanently disabled.
The issues in this case are: was the torn meniscal cartilage caused by the fall from the railcar or was this an unrelated condition? If the meniscal tear was caused by this incident, was the treatment he received reasonable and necessary, and ultimately was he truly permanently disabled?
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"Failure to Diagnosis and Treat Acute Post-Op Cervical Spine Infection"
The patient is a 36-year-old professional country Western singer who insidiously developed neck pain with burning paresthesia into the shoulder and upper extremity with some associated numbness and tingling. She saw her orthopaedic surgeon who after MRI scan found that she had neuroforaminal stenosis and degenerative disease and took her to surgery performing a cervical decompression including foraminotomy.
While admitted in the hospital, she had excellent relief of her symptoms with resolution of the burning paresthesia and symptoms into the upper extremity immediately postoperatively. However, within three days, she not only had a return of the same symptoms but they were even worse, spreading to the opposite side and causing a systemic response including low grade fever and nausea. Without any definitive workup, her treating physician placed her on an oral antibiotic and discharged her home from the hospital.
The following morning, however, she returned to the emergency room even worse with symptoms now into the ipsilateral lower extremity. The emergency department physician ordered an urgent cervical MRI scan, intravenous antibiotics and she was admitted to the care of her treating orthopaedic surgeon. The following day, however, the surgeon canceled the MRI scan and discontinued the intravenous antibiotics. He did not call for an infectious disease consult and asked the physician assistant to attempt to aspirate the cervical surgical wound area. After being advised by the physician assistant that no liquid could be aspirated, the patient was discharged home again in spite of her complaints of nausea, vomiting, fever, and increasing pain and burning, numbness and tingling into the upper and lower extremities.
The patient did not go home and instead went directly to another emergency room where she was admitted to the care of another surgeon who promptly took her to surgery and drained a large postoperative cervical epidural abscess. She developed osteomyelitis necessitating vertebrectomy and multiple additional cervical surgeries. Ultimately, she was left with a partial right hemiparesis.
The issues in this case include: misdiagnosis, the failure to treat a significant postoperative spinal infection, and disregard for the welfare of the patient.
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"Apparent Minor Traffic Accident with Neck and Back Injuries"
The patient is a 21-year-old right front seat passenger involved in a rear-end motor vehicle accident. There is no visible damage to the vehicle except a scratch to the bumper and the patient did not develop any symptoms of neck or back pain until five days later. After retaining an attorney, she embarked on a course of medical and chiropractic treatment for over two years with treatments to the neck, middle back, lower back, hips, upper and lower extremities.
The patient underwent multiple x-ray, MRI and CT analyses, all found to be normal. She was examined by neurologists, chiropractors and orthopaedic surgeons, all identifying her complaints of pain but finding nothing objectively abnormal on the physical exam. Upon discharge from treatment, she was deemed as suffering from a chronic pain syndrome that would forever permanently alter her lifestyle and need treatment.
The issues in this case include: the orthopaedic biomechanics of the claimed injuries, and what, if any, injuries were sustained at all; what treatment may have been indicated and reasonable, and what reasonable costs would have been associated with that treatment; do the medical findings truly support the diagnosis, impairment, and future medical needs?
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"Acute Carpal Tunnel Syndrome versus Chronic Continuous Repetitive Trauma Carpal Tunnel Syndrome"
The patient is a 38-year-old legal secretary who, for over 12 years, has been extensively performing data entry and keyboard work as a usual and customary part of her eight-hour job duties. On the way home from work, she was involved in a front-end motor collision. The collision was not severe enough to activate her airbags. However, she states that she was holding onto the steering wheel and suffered injuries to both wrists, neck and back.
She required no emergency treatment. However, one week later, she began physical therapy for her neck and back complaints. Six weeks after the date of incident, she began complaining of numbness and tingling in both hands and all of her fingers. Her treating physician thought she may have had a neck injury with radiculopathy and sent her for electrodiagnostic studies. Those studies, however, found the neck was not the source of her symptoms but that she was suffering from carpal tunnel syndrome bilaterally, worse on the right than the left.
With this finding, she was referred to an orthopaedic hand surgeon who promptly performed bilateral carpal tunnel release surgery and in the ultimate legal report stated that the carpal tunnel surgery was directly caused by the motor vehicle accident and blunt trauma.
The issue in this case is: the cause of the carpal tunnel syndrome and its relationship to the motor vehicle accident. Blunt force trauma to the wrists and hands is a known cause of acute carpal tunnel syndrome. However, a more common cause is continuous repetitive trauma such as keyboard data entry, typing and computer work. Did this patient fit the clinical pattern with supporting objective findings of an acute carpal tunnel syndrome or rather was this an incidental finding and representative only of continuous trauma due to her over 12 years of typing activity?
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