C1-C2 Fracture & Spinal Cord Injury

"C1-C2 fracture spinal cord injury is among the worst injuries"Among the worst injuries a person may suffer is a “broken neck,” a fracture in the cervical vertebra. It may result in irreversible paralysis or death.

The C1 and C2 vertebrae are the top two of seven vertebrae in the cervical spine. Depending upon their severity, these types of spinal cord injury are categorized as complete or incomplete.  Injuries at this top level of the spine can block nerve impulses to the rest of the body below that point, often leading to death or complete paralysis.

The C1 vertebra is also called the Atlas vertebra, named after the mythical ancient Greek hero who bore the weight of the world. The C2 vertebra is also called the Axis because it provides the ability for the head to rotate. The fracture of the C2 vertebra is often called a “Hangman’s fracture.”  The combination of C1 and C2 supports the skull, protects the spinal cords, and enables the head to rotate and swivel.

Injuries at the C1-C2 level are less common than at lower levels of the cervical spine. The most frequent causes of fractures at the C1 and C2 levels are diving, motor vehicle collisions, and falls that impact the head.

Symptoms of fractures at C1-C2 include:

  • Loss of ability to breathe without help from a ventilator
  • Loss of ability to speak
  • Loss of feeling or sensation below the level of injury
  • Paralysis of arms, hands, torso, and legs
  • Limited neck and head movement

That is why a , a C1-C2 fracture spinal cord injury is among the worst injuries a person can have. Fortunately, near our office is one of the top spinal cord injury rehabilitation facilities in the United"C1-C2 fracture spinal cord injury is among the worst injuries" States, the Shepherd Center. Over the years, families of Shepherd Center patients have often asked us to meet with them at the hospital. Prospects for the degree of recovery from such injuries include considerations of:

The outlook of a person’s recovery from a cervical vertebra injury depends on a variety of factors, including:

  • Health and fitness at the time of injury.
  • Speed of response in getting appropriate treatment and stabilizing the injury, initially with a hard collar and then typically with external fixation devices.
  • The completeness or incompleteness of  injury.
  • Prompt use of anti-inflammatory and steroid medications to relieve swelling and pressure on the spinal cord.
  • Prompt access to therapies and treatments at a specialized spinal cord rehabilitation facility such as the Shepherd Center.
  • Ability of the patient, family, friends, and caregivers to adhere to a consistent care plan.

Therefore, a C1-C2 fracture spinal cord injury is among the worst injuries a person can have.

Legal representation of a person with such an injury due to someone else’s negligence generally involves identification of all at-fault parties and insurance coverages,  coordination with the medical team and development of the life care plan, understanding of the many medical and rehabilitation issues, empathy is working with a family in severe crisis, and settlement planning to coordinate insurance and governmental benefits through a special need trust.

If you or a loved one has a cervical fracture and spinal cord injury caused by another’s negligence, call us at 404-253-7862.


Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

Ken Shigley

Ken Shigley, senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was the lead author of eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School.

Foot drop due to traumatic injury

Foot drop injury is a common complication of nerve injuries in the back, hip or legs. Also called “drop foot,” it is a result of weakness or paralysis of the muscles involved in lifting the front part of the foot.

Foot drop injury can be a frightening development for a person who is accustomed to being very active. It makes it hard to lift the front part of the foot, so it might drag on the floor when in walking. To compensate, one raises the thigh when walking as though climbing stairs (steppage gait), to help the foot clear the floor. This exaggerated gait might cause you to slap your foot down onto the floor with each step. Imagine trying to run, participate in sports, or do one’s normal work and other life activities in this condition.

I developed foot drop at age 39 due to a herniated disc at L5-S1 in the low back after a side   impact T-bone collision in an intersection.  It was frightening to find myself unable to walk normally. For weeks I had experienced increasingly severe sciatic pain, but I was unwilling to take off time from work to deal with it. Then I woke up morning to find that my leg no longer worked.  Fortunately, one of the top neurosurgeons in Atlanta was able to fit me into his schedule that week. He fixed it so that I was able to run marathons afterward. Most people are not that lucky.

The most common cause of foot drop is compression of the peroneal nerve that controls the muscles involved in lifting the foot. Traumatic injuries leading to foot drop can include fracture to tibial plateau, Patellar dislocations, ankle inversion injury, sciatic neuropathy resulting from either a traumatic injury of the hip or secondary to surgery and lumbosacral injuries.

The peroneal nerve is a branch of the sciatic nerve that wraps from the back of the knee to the front of the shin. Because it sits very close to the surface, it may be damaged easily. A pinched sciatic nerve resulting from a low back injury can cause drop foot.

Injuries to the leg or low back from car and truck accidents are a frequent cause of drop foot. That was what happened to me. Other causes include brain and spinal cord disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis, diabetes,  stroke, and muscle or nerve disorders such as muscular dystrophy, polio or Charcot-Marie-Tooth disease.  Risk factors other than traumatic injury can include activities that compress the peroneal nerve such as habitually crossing legs, prolonged kneeling or squatting, and wearing a leg cast. The peroneal nerve can also be injured during hip or knee replacement surgery, which may cause foot drop. Foot drop may also occur as a complication of abdominal or pelvic surgery or radiation treatments.

Treatments for foot drop can include:

  • Surgery to relieve the underlying nerve compression. That worked beautifully for me at 39. Unfortunately, it is not effective for everyone.
  • Physical therapy to strengthen or stretch the muscles in the leg and foot
  • Braces, splints or shoe inserts to help hold the foot in position
  • An electrical nerve stimulation implant to help the nerves work

If foot drop persists, it may qualify for a permanent impairment rating under the  American Medical Association Guides to Evaluation of Permanent Impairment, 6th Edition.

If you or a loved one has a foot drop injury caused by another’s negligence, call us at 404-253-7862.


Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

Ken Shigley, senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was the lead author of eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School

Myofascial Pain Injury

myofascial pain injury

Myofascial Pain and Dysfunction

Myofascial pain injury

Dr. Janet Travell with President Kennedy

Myofascial pain injury is common among people with soft tissue injuries to muscles and surrounding connective tissue. President John F. Kennedy suffered from chronic myofascial pain injury from World War II. His White House physician, Dr. Janet Travell, wrote the first edition of a medical treatise, Myofascial Pain and Dysfunction: The Trigger Point Manual.   We have represented many people with chronic myofascial pain resulting from injuries in a wide variety of accidents.

However, insurance claims people and defense lawyers tend to place little value on “soft tissue” injuries to muscles, tendons, and ligaments. They know that without objective, visual evidence, it is hard to persuade twelve jurors to overcome bias against soft tissue injuries. When claims of painful injuries are supported only by subjective complaints, the victims are subject to accusations of malingering, exaggerating, magnifying symptoms, or lying for money. The defense may  contest the existence of the conditions as being based upon methodologically weak “junk science.” There have been enough cases of real malingering and exaggeration to feed such suspicion. While hard trigger points are nodules that an examiner may objectively feel, critics long claimed that only the “fingers of faith” could detect them on physical examination.

Certainly, many simple muscle strains do resolve within a few weeks. Acute, localized myofascial pain can resolve spontaneously or with simple treatments. However, when myofascial pain injury becomes chronic, lasting six months or more,  with increased muscle stiffness and trigger points in muscles,  it can be debilitating and life-altering. Your injury lawyer needs to understand the medicine of myofascial pain and how to prove that injury objectively.

Myofascial Pain Injury

Feeling myofascial pain trigger point

Physical examinations of muscles with myofascial pain injury reveal trigger points, tiny. hard and extremely irritable knots located within a taut band of skeletal muscle or fascia. Trigger points can cause referred pain, local tenderness, and autonomic changes when compressed. They are painful to both touch and movement.

 

myofascial pain injury

Myofascial pain trigger points

Myofascial pain injury involves microscopic damage to muscle tissues and can become a long-term “thorn in the flesh.”  There are two types of myofascial pain trigger points: active and latent.  Active trigger points are associated with pain without movement or palpation. If you are just walking around, you may have pain with every step from an active trigger point in a hip or leg muscle. Latent trigger points are painful only to palpation. Myofascial pain syndrome involves increased muscle stiffness and trigger points in muscles.

Myofascial pain injury

Exercise is important for chronic pain

Exercise is vital to recovery from myofascial pain injury. Aerobic exercise can have an anti-inflammatory effect on muscles by increasing blood pressure, flow and oxygen saturation, allowing more blood and metabolic substrates to enter trigger points. However, as pain causes guarding of movement, physical activity may be self-limited. Therefore, low-impact forms of exercise such as swimming and water aerobics may be helpful. Adequate sleep and a healthy diet are essential for everyone, especially those with chronic pain.

Treatment for myofascial pain injury typically includes medications, trigger point injections, or physical therapy. Exercise is an integral part of any treatment program. A person who has always enjoyed recreational sports such as running or tennis may reluctantly reduce or give up such activity when it becomes painful due to injury. Chronic myofascial pain injury that naturally leads to reduced physical activity can have ripple effects of weight gain, leading to higher cholesterol levels, elevated blood pressure, and declining cardiovascular health. Additionally, chronic pain can adversely impede social interaction and sexual intimacy. Mental sharpness may also suffer s physical activity declines. Depression is a common companion of chronic pain. The overall quality of life can go into a downward spiral.

Medications used for myofascial pain injury include:

  • Pain relievers. Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may help. A doctor may prescribe stronger pain relievers. Some pain relievers are available in patches to be worn.
  • Antidepressants. For some people with myofascial pain syndrome, amitriptyline appears to reduce pain and improve sleep.
  • Sedatives. When pain causes anxiety and poor sleep, a sedative such as Clonazepam (Klonopin) might help. However, it must be used carefully because it can cause excessive drowsiness and become habit-forming.

Home exercises and physical therapy can help relieve chronic myofascial pain injury. This may include:

  • Gentle stretching exercises can help ease the pain in your affected muscle. If trigger point pain increases when stretching, a physical therapist may spray a numbing solution on the skin.
  • Posture training. Improving your posture can help relieve myofascial pain.
  • Massage along your muscle or placing pressure on specific areas of your muscle may provide myofascial release. A skillful neuromuscular massage specialist may provide great help.   Rolling the affected body area on a foam roller, bumpy roller, a therapy ball similar to a lacrosse or tennis ball, or a massage stick may provide relief at home.
  • Heat. Applying heat, via a hot pack, hot shower or hot bath, can help relieve muscle tension and reduce pain. If you have access to a whirlpool tub, myofascial pain is a great reason to use it. Using a therapy ball under the affected area while in a hot tub can be helpful.
  • Ultrasound therapy uses sound waves to increase blood circulation and warmth, which may promote healing in muscles affected by myofascial pain syndrome.
  • Needle procedures may involve either injections or dry needles. A physician
    myofascial pain injury

    Dry needling is one of the treatments for myofascial pain trigger points.

    may inject Injecting a numbing agent or a steroid into a trigger point can help relieve pain. A doctor or physical therapist may insert dry needles in and around trigger points. No numbing agent may be needed if the clinician is sufficiently skilled in locating the trigger points. Dry needling may be combined with electrical stimulation. Chiropractic treatment and acupuncture may also provide symptomatic relief for some people who have myofascial pain syndrome.

If myofascial pain injury becomes chronic — lasting more than six months — it may affect the quality of life for a long time. The average duration of symptoms of chronic myofascial pain in one study was 63 months. The range was between 6 and 180 months. If the underlying medical condition is not corrected, myofascial pain may become recalcitrant, intractable, and out of control.

Myofascial pain injury

The AMA Guides to the Evaluation of Permanent Impairment includes evaluation of chronic pain.

Permanent impairment ratings based upon chronic myofascial pain injury present a difficult analysis. The American Medical Association Guides to Evaluation of Permanent Impairment, 6th Edition, outlines the following criteria:

  • Use of prescription drugs beyond the recommended duration and/or abuse of or dependence on prescription drugs or other substances.
  • Excessive dependence on health care providers, spouse, or family.
  • Secondary physical deconditioning due to disuse and or fear-avoidance of physical activity due to pain.
  • Withdrawal from social milieu, including work, recreation, or other social contracts.
  • Failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family or recreational needs.
  • Development of psychosocial sequelae after the initial incident, including anxiety, fear-avoidance, depression, or nonorganic illness behaviors.

These criteria may be individually applied to people suffering from chronic myofascial pain injury which may cause  debilitating pain for 5 to 15 years, or longer, with a ripple effect on other aspects of physical and mental health.

So how can a personal injury lawyer prove the severe reality of a chronic myofascial pain injury?

myofascial pain injury

Sonogram and MRI can objectively show myofascial pain trigger points.

Ultrasound imaging technology is a cost-effective way to objectively visualizing trigger points related to chronic myofascial pain injury. As ultrasound equipment is common within medical offices, it is more accessible and economical that some alternatives. While primarily used for diagnosis and to guide needling treatment, the images can be invaluable as medical evidence.

Magnetic resonance imaging (MRI) can demonstrate a chronic myofascial pain injury by revealing changes in signal intensity and sites of bleeding inside muscles hematomas.  It can visualize soft tissues with excellent contrast, resolution and multiplanar assessment of muscles, especially in cases where traumatic lesions are clinically suspected. In addition, magnetic resonance elastography (MRE) can potentially improve the detection of skeletal muscle stiffness. Diffusion tensor imaging (DTI) provides a potentially excellent way to study injury to muscle structure in injured people. In the future, diffusion kurtosis imaging (DKI) and high angular resolution diffusion imaging (HARDI), could prove even better than DRI used. However, neither is yet used in clinical practice. MRI and ultrasound can detect and demonstrate tendon and ligament injuries due to disruption of the patterns of collagen and water content in the tissues.

Any such images to document a chronic myofascial pain injury can be difficult for lay people, either lawyers or jurors, to interpret. Therefore, it is advisable to supplement them with colorization of the radiology images and superb medical illustrations that a treating physician may in testimony to explain the situation clearly. Experienced trial advocates should work with top-quality medical illustrators to maximize effectiveness without exceeding the bounds of credibility and good taste.

In addition, it is crucial to marshal evidence of practical ways a chronic myofascial pain injury affects the quality of life of the injured person. It is best to find people outside the family who have observed pain behavior when the injured person did not know they were being observed.

If you or a loved one has a chronic myofascial pain injury caused by another’s negligence, call us at 404-253-7862.


Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

 Ken Shigley, senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was lead author of eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School.

Ken Shigley, senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was lead author of  eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School.

Low back fracture injuries

Low back fracture injuries often arise from high-energy events such as car and truck crashes. We have seen hundreds of them in decades of personal injury law practice.

3d render human spine anatomy with pain symptoms – back view – Grayscale Image

A fracture of a vertebra in the low back (lumbar) region causes back pain, often severe, that is aggravated by movement. When low back fracture injuries involve teh spinal cord or nerves, there may also be bowel/bladder dysfunction, numbness, tingling, or weakness in the limbs.

When low back fractrue injuries are caused by high-energy trauma, the patient may also have a brain injury and lose consciousness. There may also be other injuries—called distracting injuries—that cause pain that overwhelms the back pain. In these cases, a vertebral fracture is likely.

These can take many forms including vertebral fractures, ruptured or bulging discs, and damage to nerves, ligaments, tendons, and muscles. A single injury can have aspects of any or all of these components.

There are several varieties of low back vertebral fractures:

Compression fractures

Compression fractures are small breaks in the vertebrae that reduce the height of the vertebra. The people most vulnerable to compression fractures of spinal vertebra are post-menopausal women with reduced bone density associated with osteoporosis. With tiny cracks in soft bone, one is more vulnerable to trauma causing collapse of the vertebra. Smokers are somewhat more at risk than non-smokers. Although this can happen without a major incident, an accident such as being rear-ended by another vehicle can suddenly change the condition from merely vulnerable to acutely painful and debilitating. A common form of compression fracture involves the collapse of the front side of the vertebra. That is called a wedge fracture.   Such compression fractures can lead to chronic pain, height loss, disfigurement, impaired activities of daily living, increased risk of pressure sores, and the depression and psychological distress that commonly accompany chronic pain and loss of quality of life.

Burst low back fracture injuries

A more severe form of compression fracture is the burst fracture, which occurs when a vertebral body spread out in all directions. The increased severity is due to a couple of factors. First, bony fragments spread out in all directions bruising the spinal cord, potentially causing paralysis or other neurologic injuries. Second, when the entire margin of the vertebral body is crushed the spine is much less stable than in a wedge-type compression fracture. Burst fractures, especially in older people with brittle bones in whom it is difficult to attach plates and screws to bone, are often treated with vertebroplasty. That involves injection of bone cement into the damaged vertebra for stability and support of the spine. We have seen this most often in older women rear-ended by large trucks.

 Chance fractures / flexion-extension seat belt fractures

Named after the British radiologist who first defined it in 1948, a Chance fracture is an unstable spine fracture, usually at T10-L2, the thoracolumbar junction. About half of all spinal injuries outside of the cervical spine are this part of the spine. It is a type of flexion-extension fracture because the upper body is thrown forward, typically in a head-on collision,  while the pelvis is stabilized only  by a lap seat belt.  It is also called a  “seatbelt fracture” because it often occurs when, upon sudden deceleration, the spine forcefully bends over the lap seat belt which serves as a fulcrum, resulting in the separation of the middle and posterior elements of the spine. This was seen more often before shoulder harnesses became common.

CT and MRI scans are essential in the diagnosis and are called for when there is seatbelt bruising after a motor vehicle crash. This is a horizontal fracture extending from posterior to anterior through the spinous process, pedicles, and vertebral body. A Chance fracture is an unstable horizontal fracture extending from posterior to anterior through the spinous process, pedicles, and vertebral body. However, in about half of Chance fractures there are also concurrent intraabdominal injuries, especially spleen, bowel and bladder ruptures. Early recognition of this injury is critical as a delay in diagnosis significantly impacts clinical outcomes, but unfortunately, emergency physicians can easily overlook Chance fractures on clinical exam because patients may present without initial neurological deficits. Treatment often involves stabilization with a brace or cast, though more severe cases with neurological symptoms may are stabilized surgically.

Rotation low back fracture injuries

This less common fracture results from rotation of the low back  or extreme sideways (lateral) bending. With rotation fracture-dislocation, both bone and soft tissue around a vertebra are injured, often resulting in spinal cord compression. Treatment involves surgery to stabilize the spine, generally with places, screws, rods or cages.

Permanent Impairments after Low Back Fracture Injuries

Most lumbar spine fracture injuries involve an impairment rating under the American Medical Association Guides to Evaluation of Permanent Impairment.   Physical impairment as rated under this system is not the same thing as occupational disability. A person with a relatively low impairment rating may be completely disabled from a physically demanding occupation. But a person with the same physical impairment rating may be fully capable of doing an office job. We may also consider evaluation by a vocational rehabilitation expert to evaluate real-world disability.

If you or a loved one have suffer ed a low back fracture injury, call us at 404-253-7862.


Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

Ken Shigley, senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was lead author of  eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School.

Femur fracture injuries

The femur (thigh bone), extending from the hip to the knee, is the strongest and longest
bone in the human body. Because it is so strong, in relatively young people it usually requires a great deal of kinetic force to break the femur shaft. That often happens in truck, car and motorcycle crashes. In older people with weaker bones, however, a fall may be sufficient to fracture of the femur, especially the neck of the femur where it joins the pelvis.

In our decades of representing badly injured Georgians, we have handled numerous femur fracture cases. In one such case arising from a truck wreck, the jury in a conservative rural county surprised everyone with a verdict of $2,345,940.17. This was three times the highest previous verdict in the history of the county up until then and nearly a million dollars more than the $1.3 million we had requested in closing argument.  It reminded people of the 1982 movie, “The Verdict.”  This verdict was broken down as follows: compensatory damages: $1,742,845.70, attorney fees due to the defendant trucking company’s bad faith in violating mandatory safety rules, $580,948.57, expenses of litigation due to bad faith, $22,145.90. Medical expenses were $112,228. The highest offers from defendant’s insurance company were $100,000 the week before trial and $400,000 on third day of trial. It came from meticulously presenting the details of the injury without appearing to overreach and giving the jury a method to reach their own conclusion.

Femur fractures vary greatly, depending on the force that causes the break. The pieces of bone may line up correctly (stable fracture) or be out of alignment (displaced fracture). The skin around the fracture may be intact (closed fracture) or the bone may puncture the skin (open fracture).

Femur fractures are classified depending on:

  • The location of the fracture (the femoral shaft is divided into thirds: distal, middle, proximal
  • The pattern of the fracture (for example, the bone can break in different directions, such as crosswise, lengthwise, or in the middle)
  • Whether the skin and muscle over the bone is torn by the injury

The most common types of femoral shaft fractures include:

  • Transverse. In this type of fracture, the break is a straight horizontal line going across the femoral shaft.
  • Oblique. This type of fracture has an angled line across the shaft.
  • Spiral fracture. The fracture line encircles the shaft like the stripes on a candy cane. A twisting force to the thigh causes this type of fracture.
  • Comminuted. In this type of fracture, the bone has broken into three or more pieces. The number of bone fragments corresponds with the amount of force needed to break the bone.
  • Open. If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications—especially infections—and take a longer time to heal.
  • Any or all of these diagnostic criteria may be combined in a single injury.

Femur Fracture Diagnosis

Physical examination, combined with imaging by X-ray, CT and MRI, is used to diagnose a femur fracture and determine the exact location and pattern of fracture.

If feasible, tell the doctor should be informed how the injury occurred. The physician will look for:

  • Bony pieces that may be pushing on or through the skin
  • Deformity of the thigh/leg, such as an unusual angle, twisting, or shortening of the leg.
  • Breaks in the skin
  • Bruises

After inspecting the leg visually, the doctor will feel the thigh, leg, and searching for abnormalities and tightness of the muscles and skin of the thigh, and checking pulses. If the patient is awake, the physicians tests for sensation and movement in the leg and foot.

Treatment of a Femur Fracture

Treatment for femur fracture may vary based on the type and location of the break and may often include:

Setting the leg

A displaced fracture may require the broken bones to be realigned, prior to splinting of casting of the leg. Depending on the degree of displacement, surgical or nonsurgical methods may be used to manipulate the bones back into position.

Severe or multiple fractures may require external fixation, which uses an outer metal rod and pins to hold the bone or bones in place until they heal.

  • Open Reduction and Internal Fixation (“ORIF”) involves surgery and use of fixation devices, including an intramedullary rod or “nail” through the center of the bone, secured with various types of metal plates and screws, is used often to stabilize the broken femur during healing. This hardware is usually left in the leg permanently though sometimes it may be removed or replaced. Advantages of intramedullary nailing include quicker return to weight bearing, enhanced rehabilitation, and a high bone union and fusion rate compared with external fixation. But there are also potential disadvantages including increased risk of fat embolism, increased rates of infection and blood loss, and potential impediment to obtaining correct alignment. We have handled injury cases in which intramedullary fixation failed. In one case involving a femur shattered into several pieces, a small town hospital did not have the exact length of intramedullary rod immediately available. It was necessary to repeat the surgery a year later, and the patient had a permanent limp and a degree of permanent impairment in his occupation.
  • Immobilization through a splint or cast. Whether or not there is surgical fixation of the fracture, femur fracture treatment usually involves use of splints or casts. A college friend had a femur fracture in football. He spent his senior year in a full leg cast. While his dreams of going to the NFL were as shattered as his leg, but he chose graduate school and ultimately returned as president of the college.
  • Pain medication. Femur fractures are extremely painful. Physicians and patients must be aware of the delicate balance between pain control and risk of narcotic dependency or addiction. We know one severely injured person who was sent home with a huge quantity of hydrocodone but within a few days weaned himself off potentially addictive drugs because he needed to resume brain work, switched to over-the-counter Tylenol, and “sucked it up” for several months of recovery.
  • Physical therapy. Most patients recovering from femur fractures are prescribed months of physical therapy (“PT”) to restore normal muscle strength, range of motion, and flexibility. Patients often jokingly refer to physical therapists as “physical terrorists” because the process can be quite painful, but it’s a good pain that helps recover function.
  • Maximum medical improvement after a femur fracture usually takes about 4 to 6 months but sometimes can take a year or two.

 Permanent Impairments after Femur Fracture

In preparing for settlement or trial of femur injury cases, we typically obtain from the physician an impairment rating under the American Medical Association Guides to Evaluation of Permanent Impairment.   Physical impairment as rated under this system is not the same thing as occupational disability. A person with a relatively low impairment rating may be completely disabled from a physically demanding occupation. But a person with the same physical impairment rating may be fully capable of doing an office job. In the context of femur injuries, the determination of physical impairment involves complex tables and formulas that rate factors such as limb length discrepancy, gait derangement, muscle strength and atrophy, range of motion, arthritis, nerve injury, complex regional pain syndrome, and reduction of blood circulation. When appropriate, we also consider evaluation by a vocational rehabilitation expert to evaluate real-world disability.

 Wilderness First Aid for Femur Fractures

Most of the femur fracture injuries we see are the result of motor vehicle collisions on streets and highways.  These initially addressed by emergency medical personnel who can quickly stabilize the fracture and transport the patient by ambulance to a hospital. But if a femur fracture occurs in a remote wilderness setting beyond the reach of immediate emergency medical services, it is important to have someone in the group trained in wilderness first aid. One of our lawyers was trained years ago on how to set a displaced femur fracture in the wilderness using sticks tied off with bandanas, jackets, or t-shirts. We pray that it never becomes necessary to utilize that training.

If you or a loved one has suffered a femur fracture in a truck, car or motorcycle crash, contact us online or call us at 404-253-7862.


Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

Ken Shigley, senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was lead author of  eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School.

Atlanta Georgia Asbestos and Silica Related Lung Illness Claims

Asbestos is a naturally occurring mineral that was long used in insulation, fireproofing, and a variety of industrial applications. Thousands of years ago, it was used for candlewicks, mummy wrappings, table cloths. By the 19th century, its use exploded because  resistance to chemicals, heat, water and electricity made it an excellent insulator for the steam engines, turbines, boilers, ovens and electrical generators. Asbestos mining was done all over the world, often employing child labor to extract the mineral.

As early as ancient Roman times, people began to notice lung ailments among slaves who wove asbestos fibers into cloth. As the use of asbestos expanded in the Industrial Revolution, doctors noted such a correlation. By 1908, deaths from asbestos-clogged lungs became common. Insurance companies began excluding coverage or increasing premiums for workers who labored with asbestos. However, heavy use of asbestos continued, particularly in war production in World War II. Asbestos was included in a wide variety of products. When I was growing up, it was common in our everyday environment. The administration of my elementary school was very proud to have fireproof asbestos ceiling tiles and stage curtain. U.S. consumption of asbestos peaked in 1973 at 804,000 tons.

By the late 1970s, a the public began to recognize a connection between asbestos exposure and potentially fatal lung diseases. The first successful lawsuit for mesothelioma and asbestosis caused by asbestos exposure was in 1969. Borel v. Fibreboard Paper Products Corporation et al., 493 F.2d 1076 (5th Cir. 1973). Mr. Burrell worked 33 years as  an insulator who developed mesothelioma and from his exposure to asbestos in insulation.

Suits against companies that used asbestos in manufacturing are complex.  Beginning in the 1980s, many companies who were defendants in the asbestos litigation filed for  bankruptcy, set  money aside for present and future asbestos liabilities, and then reorganize and  exit bankruptcy and continue in business.

Asbestos-related lawsuits in Georgia are subject to special rules established by the Asbestos Claims and Silica Claims Act of 2007. O.C.G.A. § § 51-14-5 provides:

Notwithstanding any other provision of law, with respect to any asbestos claim or silica claim not barred as of May 1, 2007, the limitations period shall not begin to run until the exposed person, or any plaintiff making an asbestos claim or silica claim based on the exposed person’s exposure to asbestos or silica, obtains, or through the exercise of reasonable diligence should have obtained, prima-facie evidence of physical impairment, as defined in paragraph (17) or (18) of Code Section 51-14-3.

(17) In the context of an asbestos claim, “prima-facie evidence of physical impairment” means:

(A) For an asbestos claim that accrued before April 12, 2005:

(i) For an asbestos claim alleging mesothelioma: that a claimant alleges mesothelioma caused by exposure to asbestos, and no further prima-facie evidence of physical impairment shall be required;

(ii) For an asbestos claim alleging cancer other than mesothelioma: that a physician licensed to practice medicine (who need not be a “qualified physician” as defined in this Code section) has signed a medical report certifying to a reasonable degree of medical probability that the exposed person’s exposure to asbestos was a contributing factor to the diagnosed cancer other than mesothelioma and attaching whatever evidence the physician relied upon in determining that the exposed person has or had an asbestos related cancer; and

(iii) For an asbestos claim alleging nonmalignant injury: that a physician licensed to practice medicine (who need not be a “qualified physician” as defined in this Code section) has signed a medical report certifying to a reasonable degree of medical probability that the exposed person’s exposure to asbestos was a contributing factor to the diagnosed nonmalignant asbestos injury and attaching whatever evidence the physician relied upon in determining that the exposed person has or had a nonmalignant asbestos injury;

OCGA 51-14-3 (17)(B), et seq., provides:

(17) For an asbestos claim that accrued on or after May 1, 2007:

(i) For an asbestos claim alleging mesothelioma: that a claimant alleges mesothelioma caused by exposure to asbestos, and no further prima-facie evidence of physical impairment shall be required;

(ii) For an asbestos claim alleging cancer other than mesothelioma: that a board certified internist, board certified pulmonologist, board certified pathologist, board certified occupational medicine physician, or board certified oncologist has signed a medical report certifying to a reasonable degree of medical probability that the exposed person has or had a cancer other than mesothelioma; that the cancer is a primary cancer; that exposure to asbestos was a substantial contributing factor to the diagnosed cancer; and that other potential causes (such as smoking) were not the sole or most likely cause of the injury at issue;

(iii) For an asbestos claim alleging nonmalignant injury: that a board certified internist, board certified pulmonologist, board certified pathologist, board certified occupational medicine physician, or board certified oncologist has signed a medical report stating that the exposed person suffers or suffered from a nonmalignant asbestos injury and:

(I) Verifying that the doctor signing the medical report or a medical professional or professionals employed by and under the direct supervision and control of that doctor has taken histories as defined below or, alternatively, confirming that the signing doctor is relying on such histories taken or obtained by another physician or physicians who actually treated the exposed person or who had a doctor-patient relationship with the exposed person or by a medical professional or professionals employed by and under the direct supervision and control of such other physician or physicians, with such histories to consist of the following:

(a) A detailed occupational and exposure history from the exposed person or, if the exposed person is deceased or incapable of providing such history, from the person or persons most knowledgeable about the exposures that form the basis for the asbestos claim. The history shall include all of the exposed person’s principal employments and his or her exposures to airborne contaminants that can cause pulmonary impairment, including, but not limited to, asbestos, silica, and other disease-causing dusts, and the nature, duration, and level of any such exposure; and

(b) A detailed medical and smoking history from the exposed person or, if the exposed person is deceased or incapable of providing such history, from the person or persons most knowledgeable about the exposed person’s medical and smoking history, or the exposed person’s medical records, or both, that includes a thorough review of the exposed person’s past and present medical problems and their most probable cause;

(II) Setting out the details of the exposed person’s occupational, medical, and smoking histories and verifying that at least 15 years have elapsed between the exposed person’s first exposure to asbestos and the time of diagnosis;

(III) Verifying that the exposed person has:

(a) An ILO quality 1 chest X-ray taken in accordance with all applicable state and federal regulatory standards, and that the X-ray has been read by a certified B-reader according to the ILO system of classification as showing bilateral small irregular opacities (s, t, or u) graded 1/1 or higher or bilateral diffuse pleural thickening graded b2 or higher including blunting of the costophrenic angle; provided, however, that in a death case where no pathology is available, the necessary radiologic findings may be made with a quality 2 film if a quality 1 film is not available; or

(b) Pathological asbestosis graded 1(B) or higher under the criteria published in the Asbestos-Associated Diseases, Special Issue of the Archives of Pathological and Laboratory Medicine, Volume 106, Number 11, Appendix 3, as amended from time to time;

(IV) Verifying that the exposed person has pulmonary impairment related to asbestos as demonstrated by pulmonary function testing, performed using equipment, methods of calibration, and techniques that meet the criteria incorporated in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, fifth edition, and reported as set forth in 20 C.F.R. 404, Subpt. P. App 1, Part (A) Section 3.00 (E) and (F), as amended from time to time by the American Medical Association, and the interpretative standards of the American Thoracic Society, Lung Function Testing: Selection of Reference Values and Interpretive Strategies, 144 Am. Rev. Resp. Dis. 1202- 1218 (1991), as amended from time to time by the American Thoracic Society, that shows:

(a) Forced vital capacity below the lower limit of normal and FEV1/FVC ratio, using actual values, at or above the lower limit of normal; or

(b) Total lung capacity, by plethysmography or timed gas dilution, below the lower limit of normal,

except that this subdivision (17)(B)(iii)(IV) shall not apply if the medical report includes the pathological evidence set forth in clause (17)(B)(iii)(III)(b) of this Code section;

(V)(a) Exception to pulmonary function test requirement in subdivision (17)(B)(iii)(IV) of this Code section: If the doctor signing the medical report states in the medical report that the exposed person’s medical condition or process prevents the pulmonary function test described in subdivision (17)(B)(iii)(IV) of this Code section from being performed or makes the results of such test an unreliable indicator of physical impairment, a board certified internist, board certified pulmonologist, board certified pathologist, board certified occupational medicine physician, or board certified oncologist (none of whom need be a “qualified physician” as defined in this Code section), independent from the physician signing the report required in this subdivision, must provide a report which states to a reasonable degree of medical probability that the exposed person has or had a nonmalignant asbestos related condition causing physical impairment equivalent to that required in subdivision (17)(B)(iii)(IV) of this Code section and states the reasons why the pulmonary function test could not be performed or would be an unreliable indicator of physical impairment.

(b) Exception to X-ray requirement in clause (17)(B)(iii)(III)(a) of this Code section: Alternatively and not to be used in conjunction with clause (17)(B)(iii)(V)(a) of this Code section, if the doctor signing the medical report states in the medical report that the exposed person’s medical condition or process prevents a physician from being able to diagnose or evaluate that exposed person sufficiently to make a determination as to whether that exposed person meets the requirements of clause (17)(B)(iii)(III)(a) of this Code section, the claimant may serve on each defendant a report by a board certified internist, board certified pulmonologist, board certified pathologist, board certified occupational medicine physician, or board certified oncologist (none of whom need be a “qualified physician” as defined in this Code section) that:

(1) Verifies that the physician has or had a doctor patient relationship with the exposed person;

(2) Verifies that the exposed person has or had asbestos related pulmonary impairment as demonstrated by pulmonary function testing showing:

(A) Forced vital capacity below the lower limit of normal and total lung capacity, by plethysmography, below the lower limit of normal; or

(B) Forced vital capacity below the lower limit of normal and FEV1/FVC ratio (using actual values) at or above the lower limit of normal; and

(3) Verifies that the exposed person has a chest X-ray and computed tomography scan or high resolution computed tomography scan read by the physician or a board certified internist, board certified pulmonologist, board certified pathologist, board certified occupational medicine physician, board certified oncologist, or board certified radiologist (none of whom need be a “qualified physician” as defined in this Code section) showing either bilateral pleural disease or bilateral parenchymal disease diagnosed and reported as being a consequence of asbestos exposure; and

(VI) Verifies that the doctor signing the medical report has concluded to a reasonable degree of medical probability that exposure to asbestos was a substantial contributing factor to the exposed person’s physical impairment.

Copies of the B-reading, the pulmonary function tests, including printouts of the flow volume loops and all other elements required to demonstrate compliance with the equipment, quality, interpretation, and reporting standards set forth in this paragraph (17), the medical report (in the form of an affidavit as required by subparagraph (A) of paragraph (2) of Code Section 51-14-6), and all other required reports shall be submitted as required by this chapter. All such reports, as well as all other evidence used to establish prima-facie evidence of physical impairment, must comply, to the extent applicable, with the technical recommendations for examinations, testing procedures, quality assurance, quality controls, and equipment in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, fifth edition, as amended from time to time by the American Medical Association, and the most current version of the Official Statements of the American Thoracic Society regarding lung function testing. Testing performed in a hospital or other medical facility that is fully licensed and accredited by all appropriate regulatory bodies in the state in which the facility is located is presumed to meet the requirements of this chapter. This presumption may be rebutted by evidence demonstrating that the accreditation or licensing of the hospital or other medical facility has lapsed or by providing specific facts demonstrating that the technical recommendations for examinations, testing procedures, quality assurance, quality control, and equipment have not been followed. All such reports, as well as all other evidence used to establish prima-facie evidence of physical impairment, must not be obtained through testing or examinations that violate any applicable law, regulation, licensing requirement, or medical code of practice and must not be obtained under the condition that the exposed person retain legal services in exchange for the examination, testing, or screening. Failure to attach the required reports or demonstration by any party that the reports do not satisfy the standards set forth in this paragraph (17) shall result in the dismissal of the asbestos claim, without prejudice, upon motion of any party.

(18) In the context of a silica claim, “prima-facie evidence of physical impairment” means:

(A) For a silica claim that accrued before April 12, 2005, that a physician licensed to practice medicine (who need not be a “qualified physician” as defined in this Code section) has signed a medical report certifying to a reasonable degree of medical probability that the exposed person’s exposure to silica was a contributing factor to the claimed injury and attached whatever evidence the physician relied upon in determining that the exposed person has or had a silica related injury; and

(B) For a silica claim that accrued on or after May 1, 2007:

(i) A medical report asserting that the exposed person has or had a silica related lung cancer and:

(I) Certifying to a reasonable degree of medical probability that the cancer is a primary lung cancer; and

(II) Signed by a board certified internist, board certified pulmonologist, board certified pathologist, board certified occupational medicine physician, or board certified oncologist stating to a reasonable degree of medical probability that exposure to silica was a substantial contributing factor to the lung cancer with underlying silicosis demonstrated by an X-ray that has been read by a certified B-reader according to the ILO system of classification as showing bilateral nodular opacities (p, q, or r) occurring primarily in the upper lung fields, graded 1/1 or higher, and that the lung cancer was not more probably the sole result of causes other than the silica exposure revealed by the exposed person’s occupational, silica exposure, medical, and smoking histories;

(ii) A medical report asserting that the exposed person has or had silica related progressive massive fibrosis or acute silicoproteinosis, or silicosis complicated by documented tuberculosis, signed by a board certified internist, board certified pulmonologist, board certified pathologist, board certified occupational medicine physician, or board certified oncologist; or

(iii) A medical report signed by a board certified internist, board certified pulmonologist, board certified pathologist, board certified occupational medicine physician, or board certified oncologist stating that the exposed person suffers from other stages of nonmalignant disease related to silicosis other than those set forth in divisions (i) and (ii) of this subparagraph, and:

(I) Verifying that the doctor signing the medical report or a medical professional or professionals employed by and under the direct supervision and control of that doctor has taken histories as defined below or, alternatively, confirming that the signing doctor is relying on such histories taken or obtained by another physician or physicians who actually treated the exposed person or who had a doctor-patient relationship with the exposed person or by a medical professional or professionals employed by and under the direct supervision and control of such other physician or physicians, with such histories to consist of the following:

(a) A detailed occupational and exposure history from the exposed person or, if the exposed person is deceased or incapable of providing such history, from the person or persons most knowledgeable about the exposures that form the basis for the silica claim. The history shall include all of the exposed person’s principal employments and his or her exposures to airborne contaminants that can cause pulmonary impairment, including, but not limited to, asbestos, silica, and other disease-causing dusts, and the nature, duration, and level of any such exposure; and

(b) A detailed medical and smoking history from the exposed person or, if the exposed person is deceased or incapable of providing such history, from the person or persons most knowledgeable about the exposed person’s medical and smoking history, or the exposed person’s medical records, or both, that includes a thorough review of the exposed person’s past and present medical problems and their most probable cause;

(II) Setting out the details of the exposed person’s occupational, medical, and smoking histories and verifying a sufficient latency period for the applicable stage of silicosis;

(III) Verifying that the exposed person has at least Class 2 or higher impairment due to silicosis, as set forth in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, fifth edition, as amended from time to time by the American Medical Association and:

(a) Has an ILO quality 1 chest X-ray taken in accordance with all applicable state and federal regulatory standards, and that the X-ray has been read by a certified B-reader according to the ILO system of classification as showing bilateral nodular opacities (p, q, or r) occurring primarily in the upper lung fields, graded 1/1 or higher; provided, however, that in a death case where no pathology is available, the necessary radiologic findings may be made with a quality 2 film if a quality 1 film is not available; or

(b) Has pathological demonstration of classic silicotic nodules exceeding 1 centimeter in diameter as set forth in 112 Archives of Pathological & Laboratory Medicine 7 (July 1988), as amended from time to time; and

(IV) Verifying that the doctor signing the medical report has concluded to a reasonable degree of medical probability that the exposure to silica was a substantial contributing factor to the exposed person’s physical impairment.

 

Copies of the B-reading, the pulmonary function tests, including printouts of the flow volume loops and all other elements required to demonstrate compliance with the equipment, quality, interpretation, and reporting standards set forth in this paragraph (18), and the medical report (in the form of an affidavit as required by subparagraph (A) of paragraph (2) of Code Section 51-14-6), and all other required reports shall be submitted as required by this chapter. All such reports, as well as all other evidence used to establish prima-facie evidence of physical impairment, must comply, to the extent applicable, with the technical recommendations for examinations, testing procedures, quality assurance, quality controls, and equipment in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, fifth edition, as amended from time to time by the American Medical Association, and the most current version of the Official Statements of the American Thoracic Society regarding lung function testing. Testing performed in a hospital or other medical facility that is fully licensed and accredited by all appropriate regulatory bodies in the state in which the facility is located is presumed to meet the requirements of this chapter. This presumption may be rebutted by evidence demonstrating that the accreditation or licensing of the hospital or other medical facility has lapsed or by providing specific facts demonstrating that the technical recommendations for examinations, testing procedures, quality assurance, quality control, and equipment have not been followed. All such reports, as well as all other evidence used to establish prima-facie evidence of physical impairment, must not be obtained through testing or examinations that violate any applicable law, regulation, licensing requirement, or medical code of practice, and must not be obtained under the condition that the exposed person retain legal services in exchange for the examination, testing, or screening. Failure to attach the required reports or demonstration by any party that the reports do not satisfy the standards set forth in this paragraph (18) shall result in the dismissal of the silica claim, without prejudice, upon motion of any party.

(19) “Qualified physician” means a medical doctor, who:

(A) Spends no more than 35 percent of his or her professional practice time in providing consulting or expert services in connection with actual or potential civil actions, and whose medical group, professional corporation, clinic, or other affiliated group earns not more than 50 percent of its revenues from providing such services; provided, however, that the trial court, in its discretion, may allow a physician who meets the other requirements of this chapter but does not meet the time and revenue requirements of this subparagraph to submit a report required by this chapter if the trial court first makes an evidentiary finding (after all parties have had a reasonable opportunity to present evidence) that it would be manifestly unjust not to allow the physician at issue to submit the report and makes specific and detailed findings, setting forth the bases therefor, that the physician’s opinions appear to be reliable medical opinions in that they are supported by documented, reliable medical evidence that was obtained through testing or examinations that comply with and do not violate any applicable law, regulation, licensing requirement, or medical code of practice and that the opinions are not the product of bias or the result of financial influence due to his or her role as a paid expert. The cost of retaining another physician who is qualified pursuant to this subparagraph for the purpose of submitting a report required by this chapter may not be considered in determining manifest injustice, but the availability or unavailability of other physicians who meet the time and revenue requirements of this subparagraph shall be considered as a relevant factor; and

(B) Does not require as a condition of diagnosing, examining, testing, screening, or treating the exposed person that legal services be retained by the exposed person or any other person pursuing an asbestos or silica claim based on the exposed person’s exposure to asbestos or silica.

The board certified internist, board certified pulmonologist, board certified pathologist, board certified occupational medicine physician, or board certified oncologist who submits a report under this chapter may be an expert witness retained by counsel for the exposed person or claimant, so long as the physician otherwise meets the requirements of this chapter and any other applicable Code sections governing the qualifications of expert witnesses.

(20) “Silica” means a group of naturally occurring crystalline forms of silicon dioxide, including, but not limited to, quartz and silica sand, whether in the form of respirable free silica or any quartz- containing or crystalline silica-containing dust, in the form of a quartz- containing by-product or crystalline silica-containing by-product, or dust released from individual or commercial use, release, or disturbance of silica sand, silicon dioxide, or crystalline-silica containing media, consumables, or materials.

(21)(A) “Silica claim” means any claim, wherever or whenever made, for damages, losses, indemnification, contribution, loss of consortium, or other relief arising out of, based on, or in any way related to the health effects of exposure to silica, including, but not limited to:

(i) Any claim, to the extent recognized by applicable state law now or in the future, for:

(I) Personal injury or death;

(II) Mental or emotional injury;

(III) Risk or fear of disease or other injury; or

(IV) The costs of medical monitoring or surveillance; and

(ii) Any claim made by or on behalf of an exposed person or based on that exposed person’s exposure to silica, including a representative, spouse, parent, child, or other relative of the exposed person.

(B) “Silica claim” shall not mean a claim brought under:

(i) A workers’ compensation law administered by this state to provide benefits, funded by a responsible employer or its insurance carrier, for occupational diseases or injuries or for disability or death caused by occupational diseases or injuries;

(ii) The Act of April 22, 1908, known as the Federal Employers’ Liability Act, 45 U.S.C. Section 51, et seq.;

(iii) The Longshore and Harbor Workers’ Compensation Act, 33 U.S.C. Sections 901-944, 948-950; or

(iv) The Federal Employees Compensation Act, 5 U.S.C. Chapter 81.

(22) “Silicosis” means nodular interstitial fibrosis of the lung produced by inhalation of silica.

(23) “Substantial contributing factor” means that exposure to asbestos or silica took place on a regular basis over an extended period of time and in close proximity to the exposed person and was a factor without which the physical impairment in question would not have occurred.

(24) “Total lung capacity” means the volume of gas contained in the lungs at the end of a maximal inspiration.


If you or a loved one has suffered from mesothelioma, asbestosis, or other asbestos- related illness, contact us online or call us at 404-253-7862.

 


Johnson & Ward has been a leading personal injury specialty law firm in Atlanta since 1949.

Ken Shigley is a former president of the State Bar of Georgia (2011-12), triple board certified by the National Board of Trial Advocacy, recipient of the Traditions of Excellence Award for lifetime achievement, and was lead author of Georgia Law of Torts: Trial Preparation and Practice (2010-21). He graduated from Furman University and Emory University Law School.

 

 

 

Femur fracture injuries

Femur fracture injuries are serious, painful, and often cause some degree of permanent impairment. Your femur (thigh bone)  is the longest, thickest, and biggest bone in your body. It takes a lot of force to break the femur. A femur fracture may involve a break, crack, or crush injury of the bone. Auto and truck collisions are the most common cause of femur fractures.

The long, straight part of the femur is called the femoral shaft.  Femur fracture injuries anywhere along this length of bone is called a femoral shaft fracture. Fractures that break completely through the bone, or cause the bone to be displaced or crushed, require immediate surgery.  These are classified in several ways:

 

Femur fracture injuries are classified in several was:

Stable fracture: fragments of the broken bone line up correctly.

  • Displaced fracture: broken bone fragments are out of alignment and must be put back in line.
  • Closed fracture: the skin around the fracture remains be intact
  • Open fracture: the broken bone has punctured the skin.
  • Location of fracture:
  • Pattern of fracture
    • Transverse fracture: a break is a straight horizontal line across the femoral shaft.
    • Oblique fracture: a break is an angled line across the shaft.

    • Spiral fracture: Twisting force causes a fracture line that spirals around the shaft like stripes on a barber pole or candy cane.
    • Comminuted fracture: bone has broken into three or more pieces.
    • Open or compound fracture: bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture. This involves increased damage to the surrounding muscles, tendons, and ligaments, and higher risk for complications—especially infections—and take longer to heal.

Femoral fractures often require complex surgery. When a surgeon opens up the thigh to put bone fragments back in proper alignment that is call “open reduction.” That contrasts with “closed reduction” in which a surgeon is able to align bones fragments without cutting. When the surgeon uses rods (also called nails), screws and other hardware to secure the fragments together, that is called “internal fixation.” The entire procedure is “open reduction – internal fixation,” abbreviated as “ORIF.”   Rods (nails) inserted in the middle of the femoral shaft and secured with screws, plates, and wires. This internal hardware is usually left in the body long-term.

Some also required external fixation devices temporarily on the outside of the thigh. Complications may arise if these devices are misaligned in any way, or with infection, nerve damage, blood clots, and bones setting in incorrect positions. Sometimes more than one operation is required.

We have handled many cases involving complex femur fractures, working closely with treating orthopedic surgeons to accurately communicate the full reality of such injuries, including impairment ratings, disability factors, and custom medical illustrations.

In one femur fracture case arising from a truck wreck in a conservative,  rural Georgia county, Ken Shigley obtained a jury verdict of $2,345,940.17, roughly $1.2 million more than we asked for. That was the result of providing the jury a method of determining value in such a manner that the jurors decided to award more than the amount that we asked for in closing arguments.

If you or a loved one has suffered a femur fracture due to a truck crash or other traumatic injury, call us at 404-253-7862.


Johnson & Ward has been a leading personal injury specialty law firm in Atlanta since 1949.
Ken Shigley is a former president of the State Bar of Georgia (2011-12), triple board certified by the National Board of Trial Advocacy, recipient of the Traditions of Excellence Award for lifetime achievement, and was lead author of Georgia Law of Torts: Trial Preparation and Practice (2010-21). He graduated from Furman University and Emory University Law School.
John Adkins specializes in personal injury and wrongful death litigation. He is an honor graduate of Kennesaw State University and Thomas Jefferson School of Law in San Diego.
Ed Stone specializes in personal injury and wrongful death litigation. He is a graduate of Kennesaw State University and John Marshall Law School in Atlanta.

 

 

 

Syringomyelia and Chiari Malformation Injuries

Syringomyelia and Chiari malformations are relatively rare, closely related, neurological conditions that may be congenital but also may be caused or severely aggravated by trauma in an accident such as head or neck injury an automobile collision. MRI (magnetic resonance imaging) and CT (computer tomography) scans are essential to the diagnosis of both.

Physicians accustomed to dealing with musculoskeletal injuries such as fractures, disc herniations, and whiplash, often completely miss the diagnosis of these extremely painful and debilitating injuries. They may even accuse the patients of exaggeration or malingering.

Chiari malformation is a little-understood condition in which the lowest area of the brain, the cerebellar tonsil, is forced out of the normal place inside the skull. While generally a congenital preexisting condition, it may have been asymptomatic and undiagnosed until aggravated by trauma. This in turn may compress portions of the brainstem and upper spinal cord, causing severe headaches, dizziness, vertigo, clumsiness, vision problems, spastic movement of limbs, and numbness or weakness in arms and legs. It may lead to paralysis.

A woman was a brilliant, successful professional when she was involved in an apparently minor car wreck. Doctors viewed her debilitating pain with skepticism, accusing her of malingering. She was disabled from her successful business career and virtually bedridden for years, going to close to 100 doctors before finally finding one who understood the traumatic aggravation of a previously asymptomatic congenital Chiari malformation, and how to treat it. After finally finding a medical team that knew how to treat the traumatically aggravated Chiari malformation, she recovered a good quality of life and launched a successful new career.

Recently, our firm recovered insurance policy limits of almost a million dollars for a young woman with a preexisting congenital Chiari malformation whose condition had been dormant several years before a collision with a commercial truck. Doctors who first saw her after this collision had limited understanding of Chiari malformation. Fortunately, she found her way to a neurologist deeply experienced in treating this condition. With seasoned medical care, her symptoms improved. With lawyers who understood the long-term implications of Chiari malformation, she recovered the maximum amount of money available without having to go through years of litigation and trial.

Syringomyelia is a condition of the spinal cord more often than not closely related to Chiari malformation. It is characterized by a fluid-filled cavity or cyst known as a syrinx that forms within the spinal cord. A syrinx can expand over time compressing or destroying the surrounding nerve tissue. Frequently seen symptoms include pain in the shoulders and neck, muscle weakness, pain and stiffness in the legs, numbness or decreased sensation, especially to heat and cold, scoliosis (abnormal curvature of the spine), muscle contractions, and ataxia (uncoordinated movements). It may eventually lead to paralysis and death.

There are several congenital or idiopathic causes of syringomyelia, but it also may be caused or severely aggravated by trauma in an accident. Posttraumatic syringomyelia is the term used for cases that result from trauma. Such injuries often are initially diagnosed as a mere whiplash.

World famous golfer and prominent Atlanta lawyer Bobby Jones acquired traumatic syringomyelia in a freak accident in 1929. His symptoms gradually became noticeable before he was finally diagnosed in 1950. Over the years, he progressed from leg braces, a cane,  walker,  wheelchair, and finally was confined to bed.

We represented a woman with traumatic syringomyelia who was fortunate to get to a highly rated neurosurgeon who was able to relieve excess pressure from the syringe in her spinal cord. We were able to recover before trial the maximum of all insurance coverage available. She went on to become prominent in advocacy for people with syringomyelia while developing a successful real estate sales career.

If you or a loved one has received a diagnosis of Chiari malformation or syringomyelia after a truck crash or other traumatic injury, call us at 404-253-7862.


Johnson & Ward has been a leading personal injury specialty law firm in Atlanta since 1949.
Ken Shigley is a former president of the State Bar of Georgia (2011-12), triple board certified by the National Board of Trial Advocacy, recipient of the Traditions of Excellence Award for lifetime achievement, and was lead author of Georgia Law of Torts: Trial Preparation and Practice (2010-21). He graduated from Furman University and Emory University Law School.
John Adkins specializes in personal injury and wrongful death litigation. He is an honor graduate of Kennesaw State University and Thomas Jefferson School of Law in San Diego.
Ed Stone specializes in personal injury and wrongful death litigation. He is a graduate of Kennesaw State University and John Marshall Law School in Atlanta.

 

Due to the unvaccinated, it is a terrible time to be badly injured in Georgia

For decades, I have represented the victims of catastrophic car and truck crashes. The most seriously hurt among them, with brain and spinal cord injuries, owed their survival in the days and weeks after injury to treatment in trauma centers and Intensive Care Units (ICU). Only later were they even eligible to benefit from excellent rehabilitation programs such as those at Shepherd and Emory.

Now ICU capacity at Georgia hospitals is virtually exhausted due to treatment of Covid-19 patients, about 97% of whom are unvaccinated. Both the physical capacity of hospitals in terms of ICU bed space and the human capacity in terms of trained staff are at a breaking point.

Ambulances transporting injury victims are being diverted from hospitals that are over capacity with unvaccinated Covid patients. Both hospitals with  Level 5 trauma centers in metro Atlanta,   Grady Hospital, and Wellstar Atlanta Medical Center,  this week are on “total diversion,” as emergency and ICU rooms are full. A trauma victim who normally would go straight to one of these hospitals, may not get in. Piedmont, Northside, and Emory Midtown are also diverting emergency patients because they are over capacity with most-unvaccinated Covid patients. Even if a trauma victim is accepted in an ER, there may be severe delay of treatment due to saturation of hospital capacity.

A friend who was a long-time ICU nurse at a major Atlanta hospital spent her last several months before retirement in the “war zone” of the first wave of Covid-19.  Like many dedicated medical personnel, the demands of the pandemic drove her to the decision to retire for the protection of her health and the well-being of her family. Seasoned ICU nurses are not easily replaced.

If a loved one is badly injured in Georgia today, with life depending on access to the best medical care, such access may be delayed by the decisions of people who chose not to get a readily available vaccine.

If you are hesitant to be vaccinated against Covid-19, remember that it’s not all about you. If your decision to forego vaccination lands you in a crowded ICU, it could be fatal to some innocent person suffering an unrelated injury or other medical crisis.


Call us today at our Atlanta office 404-253-7862 or submit your inquiry online, and find out if we can help.

A senior counsel in the firm of Johnson & Ward, Ken Shigley is a 2019 recipient of the “Tradition of Excellence” Award from the State Bar of Georgia General Practice & Trial Section.

Mr. Shigley is the first Georgia lawyer to earn three national board certifications in his practice area from the National Board of Trial Advocacy – in Civil Trial Law, Civil Practice Law. and Truck Accident Law. He is one of only three Georgia lawyers to earn board certification in Truck Accident Law. He has served as a board member of the Academy of Truck Accident Attorneys, and former chair of the American Association for Justice Motor Vehicle Collision, Highway & Premises Liability Section, which includes the Trucking Litigation Group. 

He is lead author of Georgia Law of Torts: Trial Preparation and Practice, now in its eleventh annual edition with Thomson Reuters West. His law practice is focused on catastrophic injury and wrongful death including those arising from commercial trucking accidents and those involving brainneckbackspinal cordamputation, and burn injuries. 

In 2011-12, Mr. Shigley was president of the State  Bar of Georgia, which includes all the lawyers and judges in Georgia.  He also is a former chair of the Institute for Legal Education in Georgia (board member 2008-2020, chair 2012-13),  State Bar of Georgia Tort & Insurance Practice Section (1994-95), and the Georgia Insurance Law Institute (1994). A former prosecutor and former insurance defense lawyer, Mr. Shigley is a graduate of Furman University and Emory University Law SchoolMr. Shigley is a widower, father of two adult children, and an elder in his church. 



10 things to do after a car crash

A car crash can be one of the most traumatic events most people are likely to experience. It is an unexpected event that can be instantly life-changing for you and your family. There are 10 very important things that you need to do after a wreck in order to protect you, your family, and the compensation relief that you deserve.

1)                     Stay at the scene – The shock and trauma of being in an accident can cause you to not think clearly. However, it is very important that you stay at the scene of the accident and that you do NOT leave the scene. If you do leave the scene of the accident then it could imply guilt as well as result in criminal charges against you. Stay at the scene and wait for the police to arrive.

2)                     Call 911 and report the crashIt is very important that you call 911 and report the accident. Especially if you or the other party are injured. As soon as you can, call 911 and report the accident. If you call 911 first, then you will be able to explain what has happened and the events surrounding the scent better than anyone else can at that time. So call 911 and report the accident.

3)                     Do not admit fault or apologize – DO NOT say “I’m sorry” or apologize at the scene of the accident. Your judgment can be flawed in the emotions of the moment. Fault can be sorted out later. An impulsive statement can be used as an admission of guilt against you. It is very important to make sure that the police officer does not put your apology in their police report as well. So DO NOT apologize or say “I’m Sorry”.

4)                   Limit your conversation about the accident with the other party – After the crash, seek to exchange insurance information but do not get into further conversation. The other party may try to talk with you about what happened and why you did what you did or why they did what they did. It is very important that you do not engage in this type of conversation with the other party. Be polite and exchange information. If the other party tries to talk about what happened, politely refrain from such conversation until the police arrive.

5)                   Get photos and videos of the vehicles and the scene – Everyone these days has a smartphone so it is very important to remember to take pictures and videos of the scene. Try to take pictures and videos of the cars in the accident and the damage to both cars from all angles. Video the surrounding areas such as street intersections and weather conditions. Pictures and video of the surrounding area can be valuable information to your case. If the other driver was in a business vehicle, get clear photos of all writing on it. If it is a large truck get pictures of the truck door and all permit stickers.

6)                     If Injured, don’t move around – After the accident, the most common injury is a neck or back injury. This injury can be magnified or even cause permanent damage if you move around after the accident. If you feel like there is significant damage to your neck, back, or any body part then don’t move or get out of your car. Wait for the ambulance and first responders to arrive and check you out first. You may need to be carried out on a stretcher into the ambulance.

7)                     Go to the hospital if you have any injuries – At the time of the accident it is very important to take a moment and do a self-assessment of how your body is feeling. The adrenaline will be rushing through your body after an accident, so it will be difficult to feel certain pain until the adrenaline leaves your body. Take a minute and assess how you are physically feeling. Neck and back injuries will begin to hurt after the adrenaline is gone, so if there are any injuries, let the ambulance take you to the hospital to be checked out immediately.

8)                     Do not talk to the other party’s insurance company – After the accident, the other party’s insurance company will try to call you and get a statement from you of the events of the accident. They will do this over a recorded line. Other than giving the name of an attorney you have actually hired, do not talk to them or give any statements to them about the crash. The insurance company is not on your side and they are going to try and ask you questions that imply that you are guilty and responsible for the accident. Do Not speak to them.

9)                     Call our team AtlantaInjuryLawyer team at Johnson & Ward – After a motor vehicle crash,  you need advice and a road map on how to handle this traumatic experience. We have helped thousands of clients in your same situation navigate the legal process and battle the insurance companies. His experience will help you get fairly compensated and reimbursed for the injuries that you suffered. Call us at (404)253-7862.

10)                   Let your Attorney be your Advocate to the Insurance Company – The insurance company is not your advocate or your friend. Even your own insurance company does not have your best interest in mind. The insurance company works for the best interest of the insurance company. Their primary goal is to not pay out any money and then their second goal is to pay out the least amount of money possible. Let the AtlantaInjuryLawyer team at Johnson & Ward be your voice.


Ed Stone is a trial attorney specializing in personal injury law, including truck accidents, auto accidents, wrongful death, workers’ compensation, premises liability claims, dangerous or defective products,00 medical malpractice, and related Plaintiff’s tort litigation. He was born in Miami, Florida. He graduated from Kennesaw State University where he received a B.B.A. in Finance and Economics. After a first career in banking, he earned his J.D. degree from Atlanta John Marshall Law School in Atlanta, Georgia.

Member: Mr. Stone holds membership in the State Bar of Georgia and the Georgia Trial Lawyers Association. He is admitted to practice before all Georgia Superior, State, Probate, and Magistrate Courts. He is a member of Kennesaw Lodge No. 33, F & A. M., and a member of Pi Kappa Phi fraternity. Mr. Stone sits on the Board of Directors for the non-profit children’s charity, Lekotek of Georgia, founded in 1983, which has been helping families of all incomes and ethnicities whose children have physical and/or cognitive disabilities.