Vehicular Accident Case Study

We hear about terrible and often fatal motor vehicle accidents on the news every night. What we don’t hear so much about is the shocking long and short term impact these accidents have on people’s lives as they try to physically and mentally recover from their ordeals.

Our case studies will give you an idea of the types of motor vehicle accident claims that have been successful. Every individual case is different, which is why we offer a free initial consultation. This is all about helping you to know where you stand.

Motor vehicle accident claim – case study 1

Our client, Mary, was cycling along a busy suburban street when a vehicle suddenly cut across her path and collided with her. Mary fell from her bike and onto the ground sustaining a series of fractures and abrasions. The driver of the vehicle stopped briefly but did not assist Mary in any way before  fleeing the scene, unidentified.

Mary’s injuries needed significant medical treatment and she was unable to work for several months. With our support, Mary then pursued a claim against the Nominal Defendant for compensation. The Nominal Defendant is the official insurer of unidentified vehicles in Queensland. Mary’s ongoing rehabilitation was funded by the Nominal Defendant. Mary, was able to successfully win her case and claim compensation.

Motor vehicle accident claim – case study 2

Our client, John, was driving his children to school when he stopped at a red light. Barry, who was driving a utility behind John’s vehicle, was not paying due care and attention. Barry hit his brakes suddenly to avoid colliding with the rear of John’s vehicle.

The two vehicles did not collide. However, Barry was carrying a load of timber which was poorly secured to his utility. The load of timber was thrown through the rear window of John’s car causing injuries to John’s children. When John, with our support, began a motor vehicle accident claim, the compulsory third party insurer of Barry’s vehicle admitted fault. They accepted that Barry’s negligent driving and funded rehabilitation for John and his children.

Patient History

The patient is a 24-year-old woman, who was a rear passenger in a high-speed motor vehicle accident. She was properly restrained wearing a seat belt. The patient presents with focal thoracolumbar pain.

Examination

The patient is neurologically intact and only complained of severe abdominal pain.

Prior Treatment

The patient had no prior history of spinal complaints.

Images

Anterior posterior (Figure 1, enlarged in Figure 2) and lateral (Figure 3) plain radiographs demonstrate a flexion-distraction injury of T12-L1. Lateral MRI (Figure 4).


Figure 1. Anterior posterior radiograph


Figure 2. Enlargement of Figure 1


Figure 3. Lateral radiograph


Figure 4. Sagittal MRI

Diagnosis

T12-L1 flexion-distraction injury with L1 pedicle fracture and T12-L1 facet disclocation.

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Selected Treatment

A closed reduction and percutaneous reduction and stabilization procedure was performed. Fluoroscopy was used in the placement of percutanous pedicular fixation followed by rod placement and reduction of the fracture deformity. (Figures 5-8)


Figure 5. Intraoperative fluoroscopic imaging


Figure 6. Rod passage device


Figure 7. Cephalo caudal passage


Figure 8. Confirming rod passage by turning holder

Post-treatment images
The postoperative lateral plain film below (Figure 9) reveals excellent reduction and stabilization of the flexion distraction injury.


Figure 9. Posteroperative lateral radiograph


Figure 10. Postoperative wounds

Outcome

The patient's postoperative course was uneventful and she was immobilized in a brace for 3 months. At 6 months follow-up, she has minimal pain and is actively participating in a physical therapy strengthening program.

Case Discussion

Neel Anand, MD

Clinical Professor of Surgery and
Director of Spine Trauma

Cedars-Sinai Spine Center

The patient has a T12-L1 flexion distraction injury with a fracture through the L1 pedicle on the left and superior vertebral body exiting posteriorly through the T12-L1 posterior ligamentous complex. This is further accompanied by a T12-L1 facet dislocation with complete disruption of the black stripe on MRI.

I would obtain a CT scan to further define the bony anatomy, especially looking for facet morphology and posterior fractures. The patient clearly has instability and needs stabilization.

A hyperextension body cast is a reasonable treatment option, although today in 2008, that may be unacceptable to many a patient. Also given the ligamentous injury posteriorly, this may not heal with conservative care and chronic instability may result.

I would operate electively within 24- to 48-hours. The patient should be positioned to maximize lordosis and obtain postural reduction on table, which many a time is easily attainable. My preference would be a Jackson table with extra padding under the thigh and chest to maximize the lordosis.

Posterior stabilization could be achieved with a pedicle screw construct one up (T12) and one down (L2) with posterior fusion (T12 to L2) augmented with rhBMP-2 and local bone. There is no anterior column deficiency and hence a short segment construct seems very viable. There is no indication for a decompression here. The pedicle screws need to be optimized for maximum purchase by placing them parallel to the endplate in the sagittal plane and maximally toed in and convergent in the coronal plane. I would also place them as long as possible. I think that fusion is indicated here given the extensive ligamentous injury posteriorly.

My personal preference would be to treat this patient in a minimally invasive manner with percutaneous screws placed one up (T12) and one down (L2), provided that good postural reduction has been obtained. A system, allowing for free hand percutaneous placement of the rod and for locking the construct together with compression, was used. Once this is done, I would perform a selective fusion of T12-L1 facets through a paramedian incision bilaterally localized to the pedicle of L1. I would similarly augment the fusion with rhBMP-2 and local bone. If rhBMP-2 is not available, I would harvest autogenous cancellous bone from the iliac crest.

Our protocol today is to CT scan these patients at 1-year to ascertain fusion and recommend removal of the instrumentation at 1-year.

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