Category: Articles

This image illustrates the neurectomy surgery of the small finger.

Workplace traumatic hand amputation – settles for $11.1 million

This image illustrates the osteotomy done to improve thumb flexion.

Incident

Jonathan Gray was working with a large machine when his hand got caught in an unguarded pulley “pinch point”. This resulted in a traumatic degloving amputation of all digits of this 24-year-old’s left hand, requiring multiple surgeries including thumb reconstruction with toe transplantation. Long-term complications included functional compromise and ongoing pain caused by neuromas and phantom limb syndrome.

Requirement for demonstratives

Michael Sorich, of Cavanagh Sorich Law Group, required medical illustrations to show the critical trauma and intricate surgeries his client endured. The multiple dates and treatments associated with this significant injury were designed into a PowerPoint-based Interactive Timeline that organized the key medical events over a three-year period into a clear chronological presentation.

Rationale for interactive timeline format

Organizing the large number of medical events that this case entailed, including 10 surgeries and treatments, was essential to facilitate presenting each issue at trial in a manner that would not overwhelm the viewer. An interactive digital format allowed for easy navigation, simplifying the voluminous medical documentation into key dates, with layered illustrations presenting each surgical procedure one step at a time. The content was intended to serve as talking points for the experts, and a chronology anchor for all parties involved.

Outcome

This engaging and impactful presentation was used at mediation by Mr. Sorich and assisted in obtaining an $11.1 million product liability settlement for his client.

“The medical illustrations done by Artery Studios in an interactive timeline format was a key component to effectively show the magnitude of our client’s devastating injuries. The attention to detail demonstrating the multiple surgeries our client underwent played an important role in our success.”

– Michael Sorich, Cavanagh Sorich Law Group

Longitudinal and lateral traction is applied to reduce the fracture.

$8.2M win on $100k offer with medical animations

This article was published in The Trial Lawyer, Spring 2024, Volume XII, Number 1 (click here to view publication – pgs 22-26 ).

The Importance of Medical Illustrations and Animations in Trial

By Tim O’Brien and Stephen Mader

In any trial involving personal injury or wrongful death, experience shows that a simple acronym reminds the trial attorney of the channels of efforts he should employ to give his client the greatest likelihood of a successful verdict: E.L.F. Put simply, the trial lawyer must: Eliminate as many of the bad facts and as much of the “white noise” from the trial as he possibly can; Leverage the undisputed facts to the best of his client’s advantage; and Focus the juror’s attention on the right side of the disputed issues. While the E primarily is achieved through pretrial motions practice, the L and F persist through the trial from voir dire to the last word in closing argument.

Figure 1: Medical illustrations can focus the juror’s attention on the critical matters of a PI file.

Right femur fracture illustration, showing comminuted displaced femoral fracture, and hematoma/swelling.

The Use Of Medical Illustrations And Animations

One of the key mistakes of young attorneys at trial is to quickly gloss over undisputed facts and go to trial preoccupied with winning the contested issues. The thought often is, “why waste time proving something that is not in dispute?” As an advocate, it is human nature to center one’s efforts on the contested issues to prove “I’m right” and “that other guy is wrong.” But the ultimate goal is to win one thing: the trial itself. The trial attorney must leverage the undisputed facts because he will win that particular battle every single time and gain credibility for the necessary efforts to prevail on the contested issues.

The use of medical illustrations and animations at trial are critical to maximizing the leverage of the undisputed facts and properly educating the jurors so that they focus on the correct side of the disputed facts. Jurors want to feel comfortable with complex medical issues. Using medical illustrations and animations empowers the jurors to understand the medical issue and, more importantly, to appreciate the magnitude and reason for the loss the plaintiff has experienced as a result of the defendant’s negligence. However, poorly conceived and executed medical illustrations can backfire on the trial attorney and put the trial team’s credibility at risk. The conceptualization and creation of medical illustrations and animations should be done at an early stage of the litigation. Design input and approval from the treating physician or medical expert are essential.

Figure 2: Medical graphics can portray a broad range of complex issues.

Communicating visual concepts

Case Example

Mr. Michael Ngo was the restrained driver of a large SUV that hit a semi. He sustained significant right lower limb injuries including to his thigh and ankle. Radiology reports indicated that his right femur demonstrated a “…comminuted…fracture of the proximal to mid-portion of the right femoral diaphysis” with “at least one shaft width medial displacement and at least 4cm of proximal migration of the major distal fragment.” A large posterior butterfly fragment and associated soft tissue swelling were also noted. His ankle was also found to be fractured.

Surgery that the orthopedic surgeon undertook to repair the femoral (thigh) and ankle fractures involved extensive multistep procedures — as described in the three-page operative note.

To repair the thigh bone, the surgeon applied traction to the leg to make the ends of the fractured bone align. A guidewire was inserted through the center of the femur and the drilling of a central core through the marrow (referred to as “reaming of the intramedullary canal”) was performed. An “intramedullary IM rod” was placed over the guidewire and hammered through this hollowed-out central core to bridge across the fracture site to facilitate healing. Screws were then inserted through the femur to secure the rod in place, preventing it from twisting or moving. Swelling over the mid-thigh was incised with a scalpel, draining 100 mL (almost half a cup) of blood from the fracture location. A drain was placed into the wound and the incisions were then closed with staples.

Creation Of Animations For This Case

Details contained in the operative report as well as the pre-op and post-op films were complex. A full-color 3D animation was created to visually communicate the key steps that were involved to repair the femoral injury, allowing the viewer to readily understand the intricacy of the surgery, the incisions that were made (and stapled closed) and the hardware inserted into Mr. Ngo’s leg.

Steps of right femur fracture surgery.

Figure 3: Still frames from an animation demonstrating the details of a femoral fracture repair surgery.

A similar animation was created to demonstrate repair of a “…transverse medial malleolus fracture with [comminution] of the anterior medial aspect of the mortise” in a straightforward, understandable manner.

Steps of ankle fracture surgery.

Figure 4: Still frames from animation demonstrating ankle surgery to repair a fracture.

The Picture Superiority Effect

Much has been written about how visuals are better at helping people remember information. This is called the pictorial superiority effect (Snodgrass 1977, Maisto 1992, etc.), and indicates people are more likely to recall information presented to them in picture format than in text or verbal format.

Retaining complex medical information relies on working memory, which has limited capacity. Visual stimuli are processed more efficiently, and retained and retrieved from memory more effectively, than verbal stimuli. Due to this, visually explaining the medical record is critical in any case where a significant amount of unfamiliar information is being discussed — such as in a trial that involves medical issues.

This principle was applied for the creation of the animations for this case. For example, details in the OR note were far too complex for the jury to understand, let alone retain them.

Visual Communication Of The PI Case

Several ideas should be considered when visually communicating the medical content of this kind of PI file. Overloading cognitive perceptions and processing can negatively affect recall of critical information when a jury is learning about a case and later deliberating on it. Packaging complex concepts into digestible chunks of information improves understanding and aids recall. Repetition and capitalizing on different learning styles can enhance retention. Simplifying information and other visual approaches can optimize working memory and perceptions.

Make it vivid, make it believable. The essence of demonstrating this case was to show the details of both surgeries in a clear and realistic manner. A vivid portrayal of the key steps employed in the operative procedures were necessary to provide a true understanding of what was involved. The surgeries on both the femur and ankle bones were extensive, entailing incisions, alignment of fractured bone ends, removal of loose bone fragments and insertion of hardware.

Compare and contrast visual elements. This case included x-rays documenting the trauma findings as well as the postoperative appearance of the femur and ankle. However, lay people are typically unable to understand radiological images due to their technical nature and inherent medical content.

X-rays and other types of images (e.g. MRIs, CT scans), require specialized knowledge to interpret. Segments in the animations created for this case translate the x-rays into visual

representations that make them understandable by lay people, and support the 3D-modeled anatomical pre-op and post-op portrayals.

Make it memorable. With the exposition of voluminous information entailed in the PI file — much of it complex medical concepts that are difficult to recall, making the key issues stand out is paramount. Visual images are more memorable because they engage multiple senses and cognitive processes. Not only do they simplify complex concepts, they also create mental associations and evoke emotional responses, fostering a deeper understanding and retention of key information.

Accommodate different learning styles. People don’t all learn the same way. Different learners may require different forms of demonstrative evidence that optimize connection to their dominant neurological channels and cognitive perceptions. Using a combination of auditory, visual and kinesthetic stimulation (in the form of medical illustrations, animations, interactive media and 3D models), reinforces key points and maximizes information retention throughout the duration of a trial.

Build on the obvious. It’s important not to assume the jury perceives evidence as self-evident. Demonstratives in a medical case can clarify key issues, provide context, and reinforce arguments to ensure all litigation participants end up on the same page. Addressing issues proactively in visual format ensures case intricacies are presented clearly and compellingly to the jury, while reinforcing messages that may not be obvious to all.

How To Use Medical Animations Effectively At Trial

At trial, the use of these kinds of medical animations must be metered so that the jury is not desensitized to the information conveyed and the magnitude of the client’s loss. In this case example, the automobile collision caused the plaintiff to suffer significant injuries that required open reduction internal fixation of the fractures.

Use the full-length animation one time during the evidence. Let the main expert or treating surgeon stop, rewind, and emphasize critical parts of the animation as she explains the cause of the fracture, the need for the surgery, the process of the surgery, and what will be in the plaintiff’s thigh and ankle for the rest of the plaintiff’s life. The entire animation may be only three minutes long if played from beginning to end. But the animation loses its impact without the surgeon stopping as she sees fit to emphasize or teach a particular point. It is an excellent didactic tool and, at the end of the twenty to thirty minutes of testimony from the surgeon, the complex medical  issues will have been boiled down to an illustrated teaching that is no longer in length than the average American sit-com.

On cross-examination of the opposing medical expert, use quick “reels” from the animation that the expert has to agree with. The full-length animation should not be used again during the presentation of evidence: that will come later. Use stills or short reels from the animation and have them in the “holster” ready to go at the appropriate moment on cross. This is a particularly effective method to stop a narrating expert in his tracks and get back to the items that he has to concede because they are undisputed. Make the opposing expert watch the 20 to 30 second reel, and then ask simple yes/no questions about the manner of the injury, the need for the surgery, the  permanence of the hardware placement, etc. This technique serves the dual purpose of corralling the opposing expert while reminding the jury about key portions of the full-length animation they saw during the plaintiff’s case-in-chief. Stills from the animation can also be used to remind the jurors about the plaintiff’s expert testimony and to stress the magnitude of damages and permanence.

While the full-length animation should be used only once during the presentation of evidence, it can and should be used again during closing argument. This takes practice and repetition. If the animation is two minutes and 30 seconds long, the attorney should craft a portion of his closing to exactly that portion of time so that he delivers a precise argument on the magnitude of damages while having the animation running at the same time. It takes practice and repetition and refinement, but it is worth the effort. For that discrete portion of closing argument, there should a well-defined argument that has a beginning, an emotional peak, and an appeal to logic — all within the runtime of the animation. This can be done, effectively, immediately before discussing what should be filled in on the verdict form damages line.

Jurors remember a lot more of what they see than what they hear. Through the effective use of medical illustrations and animations at trial, jurors are not only educated about the medical issues, they are empowered to better understand and appreciate the magnitude of the plaintiff’s loss. Through choreographed use of the elements of these tools, the trial attorney can better leverage the value of the undisputed facts and focus the jurors’ attention on the correct aspects of the issues in dispute.

All of these techniques were used in Mr. Ngo’s case. At baseline, his case involved a right-sided ankle fracture and femoral fracture, resulting from a motor vehicle collision: at trial, the attorneys decided to proceed with no economic damages blackboard. The undersigned attorney used these trial techniques in combination with the undersigned medical illustrator author’s illustrations and animations, to aggressively leverage the undisputed facts and focus on the correct aspects of the disputed facts that needed focus. The jury returned a verdict in excess of $8.2 million in non-economic damages. Prior to trial, the maximum settlement offer from the defendant was less than $100,000.00. The use of medical illustrations helped to leverage the undisputed facts and focused the jurors’ view of the disputed facts in such a way that they regarded them as facts in the plaintiff’s favor which never should have been disputed.

 

 

All images © Artery Studios Inc.

 Timothy O’Brien is a senior shareholder at Levin Papantonio Rafferty board-certified civil trial attorney who concentrates his practice in the areas of mass tort litigation as well as single-event personal injury and wrongful death litigation.

 Stephen Mader is a Certified Medical Illustrator and the President of Artery Studios Inc., and lectures on “Sequential Medical Communication: Demonstrative evidence for the courtroom” at the graduate level.

Degloving crush injury to arm from roll-over

Incident

Mr. Black was a belted backseat passenger involved in a head-on collision with roll-over. He was thrown from the vehicle and suffered significant injuries to his upper limbs.

Purpose of illustration

This exhibit was required to demonstrate his severe right upper limb crush injury with degloving, as well as his associated fractures and 3rd degree burns. The soft-tissue and bony injuries were illustrated separately to fully communicate the extent of the trauma.

Rationale for litigation visual

Voluminous hospital reports and imaging studies noted the profound nature of Mr. Bourne’s upper limb trauma – this visual served as a summary panel for the right arm pathology.

Complications

Mr. Black required numerous upper limb surgeries, including reduction of his fractures, transplantation of skin from his thigh to cover the forearm and hand degloving, and release of elbow ankylosis that resulted from the trauma.

Other visuals demonstrated

Additional panels detailed the other surgeries performed, as well as the severe trauma to his left hand, including fractures, partial amputation of several fingers and the associated surgeries.

Outcome

The case settled at the conclusion of a two-day mediation.

“The illustrations Artery Studios creates … are always of the highest quality. They are simply indispensable as demonstrative aids in graphically illustrating both the trauma mechanism and permanency of the injuries sustained by our clients… I highly recommend Artery Studios’ involvement in any serious personal injury case.”

– Michael Lamont, Lamont Law

Double puncture of colon during gallbladder surgery – Case settles prior to trial

Incident

While undergoing cholecystectomy surgery, the anterior and posterior walls of Mr. Rossi’s transverse colon were perforated, leading to fecal peritonitis, adhesion formation and incarcerated (trapped) umbilical hernia.

Purpose of illustration

This exhibit was created to demonstrate the mechanism of injury to Mr. Rossi’s colon – as per the findings upon surgical reopening, associated imaging and the case medical reports.

Rationale for litigation visual

This illustration clarifies the complex medical terminology and difficult-to-understand radiology. It provides a clear view of what occurred during the initial surgery.

Complications

Brown fluid was observed in Mr. Rossi’s abdominal drains, and intra-abdominal air was seen on CT – indicative of a perforated bowel. He required surgical repair of the perforations, removal of pus and omentum from his abdominal hernia, and a colostomy. Later, surgical reversal of his colostomy site was undertaken along with repair of the abdominal hernia. He developed a pulmonary embolism after this surgery, resulting in his death.

Other visuals demonstrated

Additional exhibits demonstrated: the anatomy of the abdomen and intestinal tract; enlargement of Mr. Rossi’s hernia (as per CT imaging); as well the numerous surgeries performed.

Outcome

The illustrations were used at a settlement conference and the case resolved close to the doctor’s policy limits.

“Working with Artery Studios was instructive because of their knowledge of anatomy and how to illustrate it … and skills and capacity to demonstrate tissues, planes, and perspective. The images helped my understanding and to feel more confident in what we could present to a jury … and that positively impacted our settlement negotiations.”

– James Coogan, Dwyer & Coogan, PC

T-bone impact causes knee fracture – Case settles close to $1,750,000.00

Incident

When Ms. Smith was T-boned by the defendant running a red light, her right knee violently impacted the console, causing a depressed lateral tibial plateau fracture.

Purpose of illustration

This trauma panel was created to demonstrate the details of her significant intra-articular fracture.

Rationale for litigation visual

This exhibit visually ‘translated’ the confusing CT scans and medical reports into a crystal-clear illustration of her injury pathology, allowing all litigation participants to fully understand the extent of the damage.

Complications

Ms. Smith required reconstructive surgery, including elevation and reduction of the displaced bone fragments and bone grafting. Her knee was predicted to deteriorate with post-traumatic osteoarthritis and require pain management.

Other visuals demonstrated

Additional exhibits showed the surgery and complication issues, as well depictions of her concomitant brain injury which resulted in post-concussion symptoms and visual challenges.

Outcome

The case settled before trial, close to $1,750,000.00.

“The medical illustrations Artery Studios creates are always very helpful in formal settlement meetings, be it a mediation or a pretrial conference.The illustrations explain the injury to defense, and show details of any surgery and the long term consequences of the injury. Defense counsel and the adjuster realize how impactful the illustrations will be if the case proceeds to trial and the effect they can have on damages awards. Artery’s illustrations help impress my opponent with the seriousness of the case and assist me with resolution of it.”

– John McLeish, McLeish Orlando

Ruptured appendix leads to permanent brain injury – $3.2M jury award

Delayed appendicitis treatment causes hypoxic brain injury – $3.2M jury award

Incident

This 11-year-old boy with Down Syndrome suffered a ruptured appendix from delayed diagnosis and surgery, leading to unrecognized septic shock that triggered cardiopulmonary arrest, resulting in hypoxic brain injury.

Purpose of illustration

This illustration panel was created for use as an introductory exhibit, to demonstrate normal anatomy of the appendix and the pathology of early appendicitis versus Jason’s subsequent ruptured appendix with extensive ascites in his abdomen – as seen on CT.

Rationale for litigation visual

The exhibit allowed the jury to clearly understand the difference between early diagnosis of appendicitis and treating it initially, versus the significant abdominal pathology that resulted from rupture of the appendix due to delayed treatment.

Complications

Initially treated with antibiotics and a drain, he later underwent an appendectomy (which revealed interim abscess formation). The delay in surgery triggered cardiopulmonary arrest due to septic complications affecting his pacemaker wires, with a lengthy period of anoxia resulting in permanent brain injury.

Other visuals demonstrated

Additional exhibits included a series of comprehensive interactive timelines, as well as illustrations of the client’s anoxic brain injury issues.

Outcome

Prior to trial there was no settlement offer made by the defendants. The jury reached a $3.2 million verdict.

“Throughout the trial, the use of demonstrative exhibits prepared by Artery Studios was invaluable in educating the jury about the many complicated medical issues as well as the long timeline involved in this case. The exhibits and timelines prepared by Artery Studios aided us in telling our client’s story to the jury, and we believe these exhibits were instrumental in the positive result for our client.”

– Gena Romagnoli, Henry Phillip Gruss Ltd

Trauma-Induced Sciatica

Incident

This 50 year-old seat-belted driver was rear-ended at highway speeds. He suffered a lumbar spine sprain/strain injury.

Purpose of illustration

This illustration exhibit was created to demonstrate the direct anatomical link between the trauma-induced L4-5 disc herniation diagnosed post-accident, and the resultant painful sciatica symptoms of shooting burning pain into his buttock and down his leg, making it difficult to stand and walk.

Rationale for litigation exhibit

Mr. Smith had previous surgery in this area and was susceptible to further injury. The jury needed to appreciate: details of the injured disc with herniation resulting from the impact forces; associated impingement of the L4 nerve root component of the sciatic nerve; and the resultant pain that radiated through his lower back and into his left lower limb in the L4 dermatome pattern.

Complications

The L4-5 disc underwent further degenerative changes. Mr. Smith had several injections for pain, and surgery was eventually required.

Other visuals demonstrated

Additional illustrations showed: details of the mechanism of injury; an overview of how disc herniation progresses to the point of nerve root impingement; and the associated decompression surgery that was performed.

Outcome

The case settled immediately before trial was to begin.

Remote Control – Part 2

More tips for maximizing success in online mediations

In Part 1 we discussed office configuration, lighting, internet speed, and using PowerPoint to integrate photos into your video-conferenced mediations. Let’s explore how visual communications can further enhance your negotiations.

Capitalize on show-and-tell

Don’t make the mistake of being a talking head, orating about your client’s issues while eyelids grow heavy. As your comfort level with the online experience increases, up the impact of your presentations by inserting medical illustrations, animation clips, video footage, timelines, etc. As we all know, a digital interface isn’t as up-close-and-personal as meeting face-to-face, so using visuals to engage others, while explaining the complex medical facts of a file, creates a richer connection. Medical illustrations will catch and hold attention and put you firmly in the position of being the source for relevant and reliable information.

Keep all eyes on the ball – your client

One potential pitfall of video conferencing is that your client can appear postage stamp sized on screen – a problem when you want the session to be all about them. To ensure everyone keeps focused on the heart of the matter, include a photo of your client, and their name, on each of your slides. This provides a constant visual reminder of “Mr. Smith” and his trauma issues.

Tell me a story

Visual storytelling allows for not only an enhanced emotional appeal, but also provides a path for others to follow along. Visuals should be kept simple, with each slide showing one clear concept. Make the slides build on each other, telling the story one ‘paragraph’ at a time. Educational researchers refer to this as scaffolding (Pea, 2004). A presentation that builds will show the full arc of your client’s story, demonstrating evolving trauma issues, surgical procedures, or deterioration issues, in a step-by-step manner that will vividly communicate what they had to endure.

Knock it out of the park

Wrap up your client’s story with an overview chart or full-figure illustration that drives home their injury complications. Summary visuals combined with before and after photos will leave a lasting impression that’ll maximize outcomes and help resolve the file successfully.

We hope these tips will invigorate your mediations to help you get the most from your online negotiations.

Reference: Pea, R., & Mills. (2004). The Social and Technological Dimensions of Scaffolding and Related TheoreticalConcepts for Learning, Education, and Human Activity. The Journal of the Learning Sciences, 13(3).

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Remote Control – Part 1

Tips for maximizing success in online mediations

So, you’re working remotely and conducting mediations for PI files. How do you make an impact when everyone’s not in the same room? Here are some reminders for making your Zoom zing!

1 – The Camera Never Lies

We all do it – forget about the too-bright window behind you or vase of wilted flowers. First thing is to make your background look great. Rearrange your home office to show off your diplomas, a bookcase of legal tomes, maybe an anatomical model – whatever it takes to telegraph that you’re a serious and professionally-grounded PI litigator. Oh, and remember that your camera may be hi-res – so lipstick on your teeth or stubble on your chin may be clearly in focus to others!

2 – Say What?

Despite so much current online interfacing, garbled voices continue to be a recurring frustration for all. University students note that audio is the most important factor in effective online learning1. Since remote engagements are here for a while, it’s likely time to invest in a USB-plugin microphone that’ll make others hang on your every word – often for less than a hundred dollars. A headset with mic is okay, but you risk looking like a radio-host!

3 – At the Speed of Light

If you’re working from home or the cabin, now’s the time to upgrade your internet, so your engagement is crisp, without lags or the dreaded frozen screen. This may entail a new router, hooking up WiFi repeaters, or running a direct-wire internet cable to a newly-created workspace. But the investment is priceless for making your mediations unfold as smooth as silk.

4 – Lights – camera – action

Professional video bloggers (vloggers) use lighting tricks – and so should you. There are many light fixtures available that’ll cast you in a warm glow and make you clearly visible. A simple solution is a desk lamp with a 40W incandescent bulb (or LED in the 2,700-3,000 Kelvin range) shining towards you from the far side of your screen. Good lighting will make you look fresh, confident and in control.

5 – A picture of health (NOT…)

Video-conference platforms (like Zoom), cry out for visual storytelling. When you have the floor (screen), take control of the session in “presenter” mode, and hold attention by using visuals. They’ll keep your presentation on track and keep everyone focused on the key issues. Use before/after photos of your client, highlighted report excerpts, or shots of the vehicle damage. Once you get comfortable sharing your screen in mediation settings, take it up a notch with more advanced visuals that maximize outcomes – we’ll cover that in Part 2, so stay online…

(1) Findings from informal survey of University of Toronto graduate students in Biomedical Communications.

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Rollover Causes Chest Trauma with Cardiac Arrest

Incident 
This 28-year-old passenger suffered multiple injuries from a rear-end collision that caused the vehicle she was into rollover and hit a pole. 

Purpose of illustration 
This exhibit was created to demonstrate Ms. Jones’s later internal chest trauma – namely, complete collapse of the middle and lower lobes of her lung, with blood filling 70% of the right chest cavity (hemithorax) and pushing against her heart. 

Rationale for litigation visual 
Although CT scans demonstrated the chest pathology to medical professionals, non-medically-trained litigation participants needed a visual ‘translation’ of the films and case reports, thereby allowing everyone to appreciate the severity of this trauma. 

Complications 
Ms. Jones underwent a thoracotomy to remove the large volume of blood from her chest. She then suffered cardiac arrest and an emergency sternotomy was performed to evacuate blood from the pleural space and to insert chest tubes. Bleeding from the innominate artery was discovered and ligated after sharp pieces of fractured clavicle and rib were removed. 

Other visuals demonstrated 
Additional illustrations depicted: multiple rib fractures causing ‘flail chest’; spinal, right clavicular and scapular fractures; and details of three chest surgeries that were performed. Complications of scapular winging and reduced shoulder mobility due to right thoracic nerve injury, as well as thoracic outlet syndrome, were also demonstrated. 

Outcome 
A significant settlement was reached just days before the trial was to commence.

Spinal Fusion from Dump Truck Rear-Ender

Incident

This 50-year-old driver sustained significant injury when his vehicle was rear-ended by a dump truck, causing trauma to his cervical spine.

Purpose of illustration

This exhibit was created to demonstrate the appearance of his spine after it was surgically fused, providing a clear translation of the imaging and medical reports, including showing the bone grafts that were inserted to replace the bulging discs that were removed – details that were difficult to appreciate on x-rays.

Rationale for litigation visual

For those untrained in medicine, this illustration provides clarity for the complex surgery performed and hard-to-understand radiologically. It provides a concise view of what took place in the OR – showing the anterior plate affixed with screws to the vertebrae, the associated bone grafts and the incision.

Other visuals demonstrated

Additional panels illustrated the post-MVA pathology of Mr. Doe’s cervical disc bulges impinging his spinal canal, and the surgery that was required to reposition his symptomatic left ulnar nerve.

Outcome

Adam Starr of Jarve Kaplan Granato Starr LLC, used the exhibits at mediation to clearly communicate the key details of his client’s spinal pathology and required surgeries performed, securing a high six-figure settlement for his client.

Trucking Accident Triggers Stroke

Incident

This 53-year-old driver was hit by a truck twice – his car first spun and was then pinned against the concrete median – subjecting him to rotational, acceleration and deceleration forces.

Purpose of illustration

Designed to show how injury to his vertebral artery caused stroke damage to areas of his brain, this panel included details of: anatomy (arterial and cranial); physiology (bloodflow and thrombus formation); and pathology (ischemic damage).

Rationale for litigation visual

This illustration exhibit was required to allow litigation participants to connect the initial physical injury to the artery in Mr. Doe’s neck, with the resultant ischemic (stroke) damage in his brain – complex factors for most non-medically trained people to understand.

Complications

Due to instability in his upper cervical spine, he was prone to recurring transient ischemia, reducing the blood supply to his brain, causing him neurological problems.

Other visuals demonstrated

Additional illustrations showed other trauma issues of: exacerbation of pre-exisiting findings; double-crush syndrome in his upper limbs; cervical radiculopathy; rotator cuff syndrome; chronic pain, including neck, back, shoulder and leg pain; and possible future spinal surgery.

Outcome

The case settled very successfully as trial was about to begin.

Shoulder Injury from Head-on Collision

Incident

This left-handed 56-year-old driver was involved in a head-on collision, causing soft tissue damage to her left shoulder as well as other injuries.

Purpose of illustration

This panel was created to show the mechanism of injury to her AC joint and supraspinatus tendon, resulting from a significant seatbelt force being suddenly applied to her shoulder during impact.

Rationale for litigation visual

The transmission of forces from the shoulder belt, to the clavicle and thereby to the bones and tissues of the shoulder, were key concepts to be communicated at trial. The illustration served to ‘translate’ the opinion of the biomedical engineer into a visual format, allowing for clear understanding.

Complications

Ms. May went on to experience persistent pain in her shoulder, reflecting the effects of inflammation and scarring of tendons, ligaments and bursa, with secondary mechanical effects.

Other visuals demonstrated

Additional illustrations showed more detailed findings of the shoulder pathology, as well as left knee injury concepts.

Outcome

Plaintiff’s lawyer, Norma Mayer, opined that “…the illustration was instrumental in resolving the file at mediation.”

Trimalleolar Fracture-Dislocation

Incident

This 21-year-old construction worker slipped into a hole, sustaining a displaced/dislocated trimalleolar fracture that required open reduction internal fixation (ORIF). Osteoarthritis (OA) developed quickly in the joint due to the impact to, and disruption of, the articular cartilage.

Purpose of illustration

This panel was created to demonstrate the significant fracture-dislocation with associated injury to the syndesmosis (the distal tibia-fibula joint bound together by ligaments). The illustrations allowed litigation participants to fully appreciate the severity of the trauma and why OA ensued.

Rationale for litigation visual

Although x-rays demonstrated the fracture-dislocation, illustrations were required to translate the films into more readily understood images to show the full extent of trauma, including details of the syndesmosis injury.

Complications

Post-injury, this young man suffered pain on ambulation and at rest. His ankle joint demonstrated osteoarthritic degeneration within a year of the slip & fall. Some of the hardware and osteophytes required surgical removal. Further degeneration and associated surgeries were predicted for him.

Other visuals

Additional illustrations showed: the post-op appearance after ORIF surgery; hardware removal; future further osteoarthritic degeneration; and potential future ankle surgery – including debridement, fusion or replacement.

Outcome

This exhibit was created to allow the orthopedic expert to fully explain the extent of trauma this man sustained, and the significance of his intra-articular fractures. The illustrations were sent to defense and the case settled before trial.

Intra-Articular Wrist Fracture

Incident

Mr. Jones was a 45-yo male driver involved in a head-on collision and required extrication.

Purpose of Illustration

This panel was created to show details of his left wrist injury, providing a visual translation of the radiology and medical reports. It also served to demonstrate the severity of the trauma-related issue(s), to address objections of pre-existing psoriatic arthritis and two prior MVA’s with unrelated sequelae.

Rationale for litigation visual

X-rays were too difficult for a jury to comprehend understand. Other visuals showed the surgery performed and degeneration concepts resulting from the significant damage he sustained to the articular cartilage in his wrist.

Complications

He was later shown to have early arthritic changes in his left wrist joints – based on x-ray findings and a bone scan. Experts opined that his wrist would likely continue to degenerate with osteoarthritis.

Other visuals demonstrated

Concepts of: concussion; lumbar spine injury/surgery; pain treatments; sciatica complications; and right foot issues including fractures, surgeries, and degeneration. A 3D-printed model showed details of his right foot fractures.

Outcome

The demonstrative evidence was created in time for mediation. Using the visuals, the lawyer walked through the medical issues in detail, linking them directly to the biomechanical engineering opinions. A significant settlement was reached shortly thereafter with the visuals showing the clear “facts” and informing the adjuster’s decision.

Complications from TMJ Trauma

Incident

This 15-year-old pedestrian was hit by a car on the left side. She flew onto the windshield, hit her head and landed on the pavement.

Purpose of illustration

This panel was intended to show findings noted by the dental expert associated with temporomandibular joint (TMJ) injury.

Rationale for litigation visual

TMJ pathology was the primary reason for the postural instability of her jaw and contributed to ongoing headaches.

Left-sided TMJ complications

She suffered pain with jaw opening and chewing, and had left-sided jaw pain at rest. Her jaw would lock closed, with instability of the joint.

Other visuals demonstrated

Additional illustrations showed issues of: mild TBI; R-sided hemianopia; sprain/strain injury to her neck and back; head/neck/back/shoulder pain; reduced range-of-motion of her C-spine; and vision problems.

Outcome

This visual was created to allow the dental expert to better explain an essential action of the mandible; it was to be used to educate litigation participants about key anatomical and functional issues of the jaw and TMJ; the case settled just prior to jury selection at the plaintiff’s pre-trial offer.