Paediatric Orthopaedic Expert Witness: When Should You Instruct a Paediatric Orthopaedic Surgeon?

Paediatric Orthopaedic Expert Witness: Understanding the Role

A paediatric orthopaedic expert witness can provide specialist medical evidence in legal claims involving children and young people who have sustained an orthopaedic injury or developed a musculoskeletal condition.

In cases involving paediatric orthopaedic clinical negligence, childhood personal injury claims, birth injuries or complex orthopaedic conditions, it may be necessary to instruct a consultant paediatric orthopaedic surgeon to provide an independent medico-legal opinion.

The developing skeleton of a child presents different clinical considerations from those encountered in adult orthopaedic practice. Growth plates, skeletal maturity, development, limb growth and the potential for future deformity can all affect diagnosis, treatment and prognosis.

A specialist paediatric orthopaedic surgeon expert witness is therefore able to consider these issues within the context of the child’s age, development, medical history and individual circumstances.

 

What Is a Paediatric Orthopaedic Surgeon?

A paediatric orthopaedic surgeon is a specialist orthopaedic surgeon who treats disorders, injuries and conditions affecting the musculoskeletal system in children and adolescents.

Paediatric orthopaedics encompasses a broad range of conditions, including childhood trauma, developmental conditions, congenital abnormalities, limb deformity, hip disorders and neuromuscular conditions.

Children’s bones are still developing, and treatment decisions must take account of skeletal growth. The Royal College of Surgeons of England recognises paediatric orthopaedics as a specialist area in which treatment approaches can differ because children’s bones are still growing.

This specialist knowledge can be particularly valuable when a child’s injury or condition has potentially long-term consequences.

 

When Do You Need a Paediatric Orthopaedic Expert Witness?

There is no requirement for every claim involving an injured child to have a paediatric orthopaedic expert witness. The appropriate expert will depend upon the medical and legal issues that need to be addressed.

However, instructing a paediatric orthopaedic surgeon as an expert witness may be appropriate where there are questions concerning:

• The diagnosis of a child’s orthopaedic condition.
• Whether an injury was appropriately investigated.
• Whether treatment was appropriate.
• Whether surgery should have been undertaken.
• Whether there was a delay in diagnosis or treatment.
• Whether an injury has affected normal growth.
• Whether a growth plate has been damaged.
• Whether a child has developed a deformity.
• Whether further surgery is likely to be required.
• The long-term prognosis following an orthopaedic injury.
• Whether an alleged breach of duty caused or materially contributed to the injury.
• The likely impact of the condition on the child’s future function.

These issues may arise in clinical negligence claims, personal injury claims, birth injury litigation and other forms of medico-legal work.

 

Paediatric Orthopaedic Expert Witness in Clinical Negligence Claims

One of the most common reasons for instructing a paediatric orthopaedic expert witness is an allegation of clinical negligence.

A child may have attended hospital, a GP surgery, an emergency department or another healthcare setting with symptoms of an orthopaedic condition. If the condition was allegedly missed, diagnosed late or treated inappropriately, specialist evidence may be required.

A paediatric orthopaedic expert may be instructed to consider whether the treatment provided met the appropriate standard and, separately, whether any alleged breach caused the injury or deterioration complained of.

These questions can be particularly important where an earlier diagnosis might have changed the treatment available to the child.

For example, medico-legal cases may involve allegations concerning delayed diagnosis of hip conditions, paediatric fractures, growth plate injuries, musculoskeletal infection or deformity.

A specialist expert can review the relevant clinical records, imaging and treatment history and provide an independent opinion on the issues within their expertise.

 

Paediatric Orthopaedic Expert Witness for Personal Injury Claims

A paediatric orthopaedic expert witness for a personal injury claim may be required where a child has suffered an injury in an accident.

Examples include injuries sustained in:

• Road traffic accidents.
• Accidents at school.
• Sporting accidents.
• Falls.
• Accidents in public places.
• Recreational accidents.
• Other circumstances giving rise to a personal injury claim.

The seriousness of an injury cannot always be determined solely by its initial presentation.

A fracture involving a growth plate, for example, may have implications for future bone growth. A child may subsequently develop altered limb alignment, limb length discrepancy or other complications.

A paediatric orthopaedic surgeon can therefore consider both the child’s current condition and the potential long-term consequences of the injury.

 

Why Are Growth Plates Important?

One of the principal reasons to instruct a paediatric orthopaedic surgeon expert witness is the importance of skeletal growth.

Children have growth plates, also known as physes, which are areas of developing tissue near the ends of long bones. Damage to a growth plate can, depending upon the circumstances, interfere with normal bone growth.

The consequences may not necessarily be immediately apparent.

A child may initially recover from an injury but subsequently develop a growth disturbance. This can result in differences in limb length, angular deformity or other functional problems.

In medico-legal litigation, the expert may therefore need to consider whether an injury has affected a growth plate, the likelihood of future growth disturbance and whether further treatment may be necessary.

This is an important distinction between many paediatric orthopaedic cases and adult orthopaedic claims.

 

Childhood Fractures and Paediatric Trauma

Children frequently present with fractures and other traumatic orthopaedic injuries.

A paediatric orthopaedic expert witness may be required where there is a dispute regarding the diagnosis, treatment or long-term outcome of a fracture.

The expert may consider:

• The type and location of the fracture.
• Whether the fracture was appropriately diagnosed.
• Whether imaging was sufficient.
• Whether reduction or surgery was required.
• Whether the chosen treatment was appropriate.
• Whether complications developed.
• Whether the injury affected skeletal growth.
• Whether there is continuing functional impairment.
• Whether further surgery is likely.

Where a fracture has resulted in deformity or restricted function, the expert may also be required to comment on the effect of the injury on the child’s activities and likely future development.

 

Paediatric Orthopaedic Expert Evidence in Birth Injury Claims

A paediatric orthopaedic surgeon expert witness can also play an important role in certain birth injury cases.

Some children with neurological or musculoskeletal injuries sustained around birth may subsequently develop orthopaedic problems requiring specialist assessment and treatment.

For example, children with cerebral palsy can develop musculoskeletal complications affecting the hips, spine and limbs. Other birth-related conditions can result in brachial plexus injury or upper limb dysfunction.

A paediatric orthopaedic expert may be able to provide evidence concerning the resulting musculoskeletal condition, functional impairment, current treatment and potential future orthopaedic intervention.

Complex birth injury claims may require evidence from several medical disciplines. Depending upon the issues, this could include paediatric neurology, obstetrics, rehabilitation medicine, physiotherapy and other specialist fields alongside paediatric orthopaedics.

 

Common Conditions Considered by Paediatric Orthopaedic Experts

The precise conditions falling within an expert’s expertise will depend upon their clinical subspecialty and current practice.

However, paediatric orthopaedic medico-legal reports may concern conditions such as:

• Developmental dysplasia of the hip.
• Slipped capital femoral epiphysis.
• Perthes disease.
• Paediatric fractures.
• Growth plate injuries.
• Limb length discrepancy.
• Limb deformity.
• Clubfoot.
• Neuromuscular conditions.
• Cerebral palsy-related orthopaedic complications.
• Paediatric sports injuries.
• Foot and ankle conditions.
• Congenital limb abnormalities.
• Musculoskeletal infection.
• Complex paediatric trauma.

Current expert witness profiles demonstrate that these areas commonly form part of specialist paediatric orthopaedic medico-legal practice.

 

What Can a Paediatric Orthopaedic Expert Witness Report Address?

The precise scope of a paediatric orthopaedic expert report will depend upon the instructions provided.

However, a report may address:

Diagnosis

The expert can consider the child’s diagnosis based upon the clinical history, examination findings, imaging and other available medical evidence.

Breach of Duty

In a clinical negligence case, the expert may be asked to consider whether the treatment or management provided was appropriate.

Causation

The expert may then consider whether an alleged breach caused or materially contributed to the injury or deterioration.

Breach of duty and causation are separate questions and should not be conflated.

Condition

The expert can describe the child’s current orthopaedic condition, including relevant symptoms, functional restrictions and clinical findings.

Prognosis

The paediatric orthopaedic expert witness may assess the likely future course of the condition and whether permanent impairment is anticipated.

Future Treatment

Where appropriate, the expert may comment on whether further surgery, physiotherapy, monitoring or other orthopaedic intervention may be required.

This can be particularly important where the child has many years of growth and development ahead.

 

Why Is Prognosis Particularly Important in Paediatric Orthopaedic Claims?

Prognosis can be more complex in children because the child’s body continues to develop.

An expert may need to consider the likely consequences of growth, whether a deformity may progress, whether further surgery may be required and whether the child’s condition is likely to affect them into adulthood.

This is one reason why paediatric orthopaedic expert evidence can be particularly valuable in claims where the child’s ultimate outcome remains uncertain.

The expert should, however, distinguish between a probable outcome and a merely possible future complication. Opinions concerning future treatment or deterioration should be expressed with appropriate clinical caution and supported by the available evidence.

 

Why Instruct a Specialist Paediatric Orthopaedic Surgeon?

A solicitor may reasonably ask why a general orthopaedic surgeon cannot provide the required report.

The answer will depend upon the case.

Where the issues concern a child’s developing skeleton, specialist paediatric expertise may provide a more appropriate evidential foundation. A consultant who routinely treats children will have specific experience of paediatric growth, childhood trauma and developmental orthopaedic conditions.

For example, specialist paediatric orthopaedic medico-legal practice can include conditions such as developmental dysplasia of the hip, slipped upper femoral epiphysis, cerebral palsy, paediatric trauma and deformity.

The correct approach is not simply to select an expert with the broadest orthopaedic qualifications. The expert should have relevant specialist expertise in the particular issues arising in the case.

 

Choosing a Paediatric Orthopaedic Expert Witness

When selecting a paediatric orthopaedic expert witness in the UK, solicitors should consider the expert’s qualifications, current clinical practice and experience in the relevant area.

Important considerations may include:

• Consultant-level paediatric orthopaedic experience.
• Relevant specialist training and qualifications.
• Current clinical practice involving children.
• Experience with the specific condition or injury.
• Experience preparing medico-legal reports.
• Experience in clinical negligence litigation.
• Experience in personal injury litigation.
• Understanding of CPR Part 35 requirements.
• Experience attending experts’ meetings.
• Experience giving oral evidence where required.
• Availability within the litigation timetable.
• Independence and impartiality.

The expert’s experience should be sufficiently relevant to the specific case rather than relying solely upon their general professional title.

 

What Is a Paediatric Orthopaedic Medico-Legal Report?

A paediatric orthopaedic medico-legal report is an independent expert report prepared for use in legal proceedings or in anticipation of proceedings.

The report should provide an objective opinion on matters falling within the expert’s professional expertise.

The expert witness’s duty is to assist the court rather than to act as an advocate for the party who instructed them. This principle is fundamental to expert evidence.

The Courts and Tribunals Judiciary provides guidance concerning expert evidence and the expert’s duty to the court.

A properly prepared report should explain the evidence relied upon and provide reasoned conclusions. Where there is uncertainty, the expert should identify it rather than presenting speculation as established fact.

 

Paediatric Orthopaedic Expert Witness and CPR Part 35

Solicitors instructing a paediatric orthopaedic expert witness should ensure that the expert understands the procedural requirements applicable to expert evidence.

CPR Part 35 governs expert evidence in civil proceedings and includes requirements concerning the expert’s duty, the content of expert reports and the court’s control over expert evidence.

The expert should remain within their area of expertise and provide an independent opinion based upon the evidence available.

This is particularly important in complex paediatric cases where multiple medical disciplines may be involved. A paediatric orthopaedic surgeon should address orthopaedic matters while avoiding conclusions that properly fall within another specialist’s field.

 

When Should Solicitors Instruct a Paediatric Orthopaedic Expert?

Early consideration of expert evidence can be beneficial where the medical issues are complex or where causation and prognosis are likely to be disputed.

Early instruction may help a solicitor understand:

• The nature and severity of the child’s injury.
• Whether the treatment provided was appropriate.
• The likely long-term consequences.
• Whether further investigations are required.
• Whether further treatment may be necessary.
• Whether another medical expert should be instructed.
• The issues that are likely to require expert evidence at trial.

It can also assist with understanding the evidential strengths and weaknesses of a claim before significant costs are incurred.

 

Conclusion: Instructing a Paediatric Orthopaedic Expert Witness

A paediatric orthopaedic expert witness provides specialist evidence in cases involving children’s bones, joints, muscles, growth and musculoskeletal development.

A paediatric orthopaedic surgeon may be particularly appropriate in clinical negligence claims, personal injury claims, birth injury cases and complex childhood orthopaedic injuries where questions arise concerning diagnosis, treatment, causation, current condition, prognosis or future treatment.

The developing skeleton means that childhood injuries cannot always be assessed in precisely the same way as adult orthopaedic injuries. Growth plate damage, skeletal development, deformity and potential future treatment may all need specialist consideration.

Instructing an appropriately qualified paediatric orthopaedic surgeon expert witness can therefore help ensure that the court receives clear, independent and clinically informed evidence on the orthopaedic issues relevant to the claim.

The selection of the expert should be based upon the particular medical questions involved, the expert’s specialist clinical experience and their ability to provide independent evidence in accordance with the requirements of the court.

For solicitors seeking a paediatric orthopaedic expert witness for clinical negligence, personal injury or other medico-legal proceedings, Expert Court Reports can assist with identifying an appropriately qualified medical expert.