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Permanent impairment case study - haematopoietic system

The following case studies relate to injuries to the Haematopoietic System.

More detailed information regarding the assessment of injuries to the haematopoietic system may be found at Chapter 8 of the permanent impairment guidelines and Chapter 7 of the AMA4 Guidelines.

We make no warranties or representation about the accuracy or completeness of the information contained in these Case Studies. It should be noted that the information contained herein is not provided as a substitute for legal advice.

Case Study # Brief Description Primary Body System Secondary Body System
H1 Splenectomy Haematopoietic Lower Limb

This matter was subject to review by a Medical Review Panel. These are the Review Panel’s findings.

Claimant’s Date of Birth: 26 January 1942

Date of Motor Accident: 7 January 2006

Injuries

Spleen – splenic rupture requiring splenectomy

Pelvis – fracture

Ribs – fracture Right wrist – fracture

Back – impact injury

Right leg – deep venous thrombosis

Panel Findings

Spleen – splenic rupture requiring splenectomy: the Panel refers to the Permanent Impairment Guidelines, MAA, 1/10/07 under the Haemopoietic System, paragraph 8.13, page 50, which states that a claimant with posttraumatic splenectomy should be assessed as having 3% whole person impairment.

Pelvis -- fracture: the panel felt that the claimant has suffered a severe pelvic injury with multiple bone fractures and soft tissue injury. The x-ray reports of the pelvic injuries stated a CT scan showed fractures involving the left sacral ala extending into the sacroiliac joint and fractures of the left Ilium and the right superior and left superior and inferior pubic rami. The Panel agreed that, unless the fractures were displaced, the assessment of impairment needed to be made with regard to undisplaced pelvic fractures. It was also agreed that permanent impairment could only be awarded if there was a displaced fracture involving the sacrum as there had been no disruption of the pubic symphysis and there was no evidence that this was the case. Therefore this injury is assessed under healed fractures without displacement as 0% WPI.

Ribs -- fracture: There is clear evidence that there is no longer any chest pain or any other symptom related to the chest and examination of the chest was normal. There was no evidence that any restricted motion of the thoracic spine was due to chest wall injury. This injury can only be assessed as 0% WPI.

Right wrist -- fracture: There was clear evidence that the undisplaced wrist fractures had healed, and there was mild residual restriction of range of motion of the wrist, which was assessed for permanent impairment with a 5% UEI (3% WPI).

Back -- impact injury: There was no dysmetria or muscle guarding of the thoracolumbar spine, and there was no radiculopathy. Assessment is DRE 1 (0% WPI).

Right leg -- deep venous thrombosis: based on the bilateral Duplex Doppler scan of the lower limbs reported in the clinical notes from the Hospital, the panel agreed that this injury should be amended to “Right leg – pelvic deep venous thrombosis” which was caused or contributed to by the motor vehicle accident. The Panel agreed that there was some degree of pelvic venous obstruction due to the deep venous thrombosis caused by the severe pelvic injury due to the motor vehicle accident and this causes some degree of swelling the of the legs, which is controlled by elastic stockings This injury was assessed according to the AMA Guides Fourth Edition, table 69, page 89 as Class 1. All three criteria for Class 1 were present, of which only the second criterion is a positive finding whereas the other two are negative findings. The panel believed that a lower extremity impairment of 3% was appropriate, which converts to 1% WPI.

Panel decision

The whole person permanent impairment of the injuries caused by the accident was calculated as follows:

  Body Part or System AMA Guides/ MAA Guidelines References (chapter/ page/table) Stabilised (YES/NO) Current %WPI* %WPI* from pre-existing OR subsequent causes %WPI* due to motor accident
1. Spleen – splenic rupture requiring splenectomy MAA Guidelines, 1/10/07, page 50, paragraph 8.13 Yes 3% 0% 3%
2. Pelvis - fractures AMA Guides 4th Edition, page131, section 3.4 Yes 0% 0% 0%
3. Ribs - fracture AMA Guides 4th Edition, non assessable Yes 0% 0% 0%
4. Right upper limb - wrist AMA Guides 4th Edition, Chapter 3, figure 26 page 36, figure 39 page 38 UEI: 5% Yes 3% 0% 3%
5. Thoracolumbar spine AMA Guides 4th Edition Chapter 3 table 74, page 111 Yes 0% 0% 0%
6. Right lower extremity – pelvic deep venous thrombosis AMA Guides 4th Edition, Chapter 3, table 69, page 89 Class 1 LEI: 3% Yes 1% 0% 1%

Total Combined Permanent Impairment is 7%

* %WPI = percentage whole person impairment

Determination Regarding the Degree of Whole Person Impairment of the Injured Person as a Result of the Injuries Caused by the Motor Accident

The total percentage whole person permanent impairment for assessed injuries caused by the motor accident is 7%. Therefore the total whole person impairment is not greater than 10%.