Tuesday, May 2, 2017

Family Doctor Fails to Notice Limp Limb in Infant. Hip Dysplasia

Minor Plaintiff vs. Defendant Family Practitioner State of Michigan $127,500.00 settlement. This is a medical malpractice action based on defendant family practitioner’s failure to timely diagnose congenital hip dysplasia in minor Plaintiff. Minor Plaintiff was born with congenital hip dysplasia (“CHD”) that was not diagnosed until 14 months of age. Surgery ensued, casting, immobility and medical attention followed. As a result of the delay, minor Plaintiff was subjected to additional and more invasive surgeries, required additional medical follow-up and experiences disfiguration, has an abnormal gait, has increased risk of avascular necrosis and will likely need hip replacement when older. Defendant pediatrician saw minor Plaintiff routinely during her first year for well visits. During these visits defendant should have diagnosed hip dysplasia and did not. Congenital hip dysplasia occurs when a child is born with an unstable hip due to abnormal formation of the hip joint during the early stages of fetal development. Another name for this condition is developmental dysplasia of the hip. The ball and socket joint in the hip may sometimes dislocate. Statistics show one out of every 1,000 infants is born with a dislocated hip. The cause is unknown. The standard of care is to screen for congenital hip dysplasia from birth and throughout the first year of the child’s life. The most common screening method is a physical examination where the pediatrician will gently maneuver the child’s hips and legs while listening for clicking or clunking sounds that may indicate a dislocation. These tests are generally utilized for children up to three months of age. The instability worsens with age. Older babies’ findings that indicate CHD include limping, limited abduction and a difference in leg lengths if they have a single hip affected. Imaging tests can confirm a CHD diagnosis. If detected early enough, a child may be placed in a harness which abducts the hip by securing their legs in a frog-leg position. The baby may wear this harness for 6 to 12 weeks depending on their age and the severity of the condition. Also, the baby may need to wear the harness full time or part time. If the harness application is unsuccessful, surgery is generally indicated. After the baby’s hip is placed into position, their hips and legs will be casted for at least 1-2 months in a SPICA cast. In this case, minor Plaintiff was not afforded treatment at an early age, and therefore extensive open reduction surgery was necessitated. It is estimated that between 80 and 95 percent of cases identified early receive successful treatment, depending on the severity of the condition. The complicated and more invasive treatment is less likely to be necessary when the doctor identifies the CHD early and provides appropriate treatment. Once treated, the child will likely continue regular visits with an orthopedic specialist to insure the hip is growing normally. In this case, defendant pediatrician examined minor Plaintiff at 9 days, 14 days, 8 weeks, 4 months and 6 months. By the age of six months, the minor’s parents observed asymmetrical folds in her right thigh and buttocks area and informed defendant doctor of the same at the six month visit. There is no mention by defendant physician of the concerns conveyed to her. The abnormalities in skin folds were still present again at the nine month visit, and then the 12 month visit. Again, no mention was made in the record. Shortly thereafter, minor Plaintiff began to walk and had an obvious limp, was walking like she had one high heel on and noticed one leg was longer than the other. Plaintiff mother knew an orthopedic doctor and discussed the minor’s condition with him. An x-ray revealed “suggestive of congenital right hip dysplasia.” A physical examination revealed that the right leg was externally rotated with a mild limp. The note indicates that the parents noted asymmetric thigh folds approximately six months ago, and that this was brought to the attention of the pediatrician, who told them there was nothing to be concerned about. Surgical consultation was recommended. The procedure performed was a femoral shortening, right abductor tenotomy with right hip open reduction. Minor remained in a SPICA cast for the next 6 weeks and underwent physical therapy thereafter. At 18 months, minor could stand but not walk. Minor presented again with hip dislocation and further surgery was recommended, with a Salter or Dega osteotomy to obtain better coverage for the right femoral head. Minor underwent therapy and today continues to exhibit a limp when walking and gallops when running. Plaintiff relied on experts in family practice medicine, and a treating orthopedic surgeon. Defendant violated the applicable standards of care by failing to carefully evaluate the range of motion and flexibility of minor Plaintiff’s hips and legs during her well visits. Defendant failed to recognize that asymmetrical folds in the buttocks and/or thigh of the minor were suggestive of hip dysplasia and warranted further evaluation, early diagnosis of hip dysplasia and treatment. Had defendant performed the appropriate evaluation with careful detail as per the standard of care towards hip range of motion and flexibility, performing certain maneuvers, congenital hip dysplasia would have been diagnosed, an ultrasound or x-rays should have been performed, and a referral to a pediatric orthopedic surgeon should have been made. Defendant claimed that thorough examinations were done within the standard of care, and that the condition only presented itself at 6 month of age or later and surgery at that point would have been the same, with the same outcome. As a direct and proximate result of defendant’s negligence, minor Plaintiff had an undiagnosed and untreated hip dysplasia which worsened significantly as she got older. Her risk of avascular necrosis, additional surgeries, abnormal growth of the femoral head, future delayed socket development and leg length discrepancy are all continued risks. Hip replacement surgery is most likely in the future, with revisions as she ages.

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