The aim of this paper is to stress that an expert providing medico-legal opinion in matters relating to medical malpractice, workers compensation, transport accident and other injuries should preferably be a recognised expert in the field by virtue of knowledge, training, qualification and experience, free from bias as far as is possible and willing to provide evidence if called to court. Based on over ten years experience of conducting what is now largely a medicolegal practice and recently having obtained a Post Graduate Diploma in Health/Medical Law from Melbourne University and with approximately 800 assessments conducted yearly over that period, requirements for taking a comprehensive history, carrying out a thorough physical evaluation as well as assessment of all appropriate investigations and writing a “stand alone” medicolegal report will be outlined. Also included in the final opinion should be comments on opinions given by other experts. One should also include the summarised opinion in the world literature relating to the main issue. Finally, just as a judge does when giving his judgement the reasons underlying the opinion should be fully explained. Judges throughout Australia conducting medical lists are concerned that many medical assessments appear to be biased towards the party requesting and paying for the report; ways of reducing bias will be suggested. Finally the author will give his views on the value of expert medical panels independently appointed by the courts through the learned medical colleges giving their opinion on liability and whole person impairment in medical malpractice claims, and similar to medical panels currently assessing workers compensation injury in most states in Australia.
A cortical bone graft on a muscle pedicle was taken from the ulna and transferred to bridge a complete defect of the radius in 16 dogs. In 14 control dogs a free graft was used, that is, one without a muscle pedicle. Union in the group with pedicle grafts was far superior to that in the group with free grafts, mainly because in those with pedicle grafts there was good subperiosteal new bone formation from active viable periosteum. In six of the pedicle grafts the viability of some osteocytes was retained over a 12-week period and in five the graft was almost completely replaced by new bone.
Subcutaneous rupture of the tendon of tibialis anterior immediately proximal to its insertion affects patients over the age of 45 years and is most common in the seventh decade. The symptoms at the time of rupture are milder than is the case with rupture of the calcaneal tendon and the early disability is slight. Thus, affected patients commonly present several weeks or months after rupture and at a stage when reattachment of the tendon to its normal site of insertion (the most satisfactory surgical management) is impossible. Although the disability is slight if repair is not performed, there should be no disability after surgical repair and this should be offered to those patients who lead an active life and who present in the first three months after rupture. The relevant literature is reviewed and experience with four further patients is recounted.