Life after limb loss or amputation

Traumatic injury resulting in limb loss? An amputation lawyer can help.

Nearly 60 million people worldwide live with limb amputation due to traumatic causes. Among the leading traumatic causes of limb amputation are road injuries (15.7%) and other transportation injuries (11.2%), according to an April 2021 article in Prosthetics and Orthotics International. As obviated by these numbers, semi-truck crashes, car accidents and motorcycle accidents can cause catastrophic permanent injuries that lead to amputations. Injuries resulting in amputation are more prevalent in crashes involving a size/weight mismatch, such as an 18-wheeler semi-truck, box delivery truck or commercial cargo van slamming into a car or motorcycle. Type of crash (roll-over, T-bone, side impact) can also lead to the greater likelihood of crush injuries or limb separation due to force. A crash that causes entrapment or impingement of a limb can cause loss of blood flow and result in local hypoxia, when a region of the body is deprived of adequate oxygen supply at the tissue level leading to the unfortunate necessity for amputation.

When a limb is lost, the impacts are devastating. In our own backyard (Longmont, Colorado), a local man lost his left foot in a hit-and-run crash in July 2021 while riding his motorcycle at night. He was thrown 50 feet by the impact, and was saved from bleeding out by another random driver near the scene who stopped and applied a tourniquet made from a belt. The hit-and-run driver who fled the scene was found, arrested, and charged with careless driving, failure to report a crash, and failing to yield right-of-way. However, that was a hollow win for the motorcyclist, who was wearing proper gear and boots, but still lost his foot in the crash.

Amputation of a limb is a life-changing operation that results in profound alterations in the physical and psychological welfare of the patient. While nothing can restore the amputee’s life to pre-crash standards, the American civil justice system can hold the at-fault party responsible through monetary compensation. Especially in amputation cases when the losses are extraordinary, and the costs of treatment and long-term care are staggering, our legal system can provide the financial resources necessary to rebuild quality of life, while holding the defendants accountable. You need an amputation lawyer who understands the injuries and lifetime costs.

Economic Losses in Amputation Cases: Medical Bills

Surgeries: Medical bills for clients with amputations can easily reach $500,000 to $1,000,000, as an injured person may undergo multiple surgeries to save the limb prior to amputation. In particular, below-the-knee amputations run a higher risk of infection, often resulting in a second above-the-knee amputation later in life. The unfortunate likelihood of that surgery must be built into the accounting for future medical care. Amputees share many stories in this regard, as efforts to save limbs often fail. At the Amputee Coalition website, there are dozens of first-hand accounts of more surgeries, limb salvage, ankle fusion, external fixators limb, lengthening muscle flaps – basically any medical intervention to get out of pain. Far too often these individuals end up electing to undergo further amputation to stem the infections, complications, and pain. A good amputation lawyer will account for this possibility in future treatment costs.

Prosthesis: Another important financial issue in amputation cases is the cost of the prosthetic limbs and the replacement of the prosthesis multiple times over the course of the client’s life. One prosthetic is generally agreed not to be enough for a person, as different prosthetics have different purposes. In the case of a leg amputation – one for walking and a waterproof, slide resistant prosthetic for bathing. In the case of an amputated arm, the hand prosthetics can be very complex and sustain repetitive wear. For this reason, every few years the prosthetics must be replaced to maintain functionality. The cost for prosthetics, their parts and replacement over a lifetime can exceed $1.5 million.

According to the Amputee Coalition in Colorado: For persons with a unilateral lower-extremity amputation, the two-year healthcare costs, including initial hospitalization, inpatient rehabilitation, outpatient physical therapy, and purchase and maintenance of a prosthetic device, is estimated to be $91,106. The lifetime healthcare cost for persons with a unilateral lower extremity amputation is estimated to be more than $500,000. It is anticipated that these healthcare costs would be higher for a person with a proximal amputation level and bilateral amputation status, due to higher prosthetic costs.

New technology is paving the way for better prosthetic adoption. Three types of osseointegration systems are available in the U.S. – Swedish, Australian, and U.S. implants. Colorado boasts a surgeon who has performed osseointegration with the FDA-approved system for bone-anchored prosthesis. There are many benefits to this procedure but there are, like with any technology, some parameters for success, such as relying on the body’s unique ability to accept and integrate a titanium implant placed in the bone. Osseointegration began its journey in dental work, but the technique has expanded into digits and limbs as an alternative method of attaching a prosthetic limb to an amputee’s body. While osseointegration offers many benefits to the amputee, shown in a study to increase prosthetic use, walking speed, and quality of life, it also has issues.

According to the Annals of Plastic Surgery, the average cost of OI surgery was $54,463. Twenty percent of patients required preimplantation soft tissue revision surgery ($49,191). Complication rates per year and average costs were as follows: soft tissue infection (29%, $435), bone/implant infection (11%, $11,721), neuroma development (14%, $14,659), and mechanical failure (17%, $46,513). Aside from the post-surgery complications, the recovery from potentially multiple surgeries means that it could be one year before the prosthesis can be worn without support, and rehabilitation is required to learn to walk on the prosthetic (in the case of a leg procedure).

Orthotics: In addition to prosthetics, orthotics may be necessary to improve gait, reduce pain, allow healing, and provide support or stabilization. This is because the amputation can shift center of gravity and therefore balance, and/or cause back pain due to changes in the body’s positioning.

Rehabilitation/Physical Therapy: One important factor to recovery was rehabilitation, which improved long-term outcomes of persons with trauma-related amputations. Some of the skills that able-bodied people don’t give a second thought have to be re-learned by an amputee, such as changing clothes or footwear, with the need to practice balance and sensory reintegration, muscle re-education, and gait training. The available treatments are not cheap or easy, but it is important to do everything possible to improve mobility, limb function, maintain limb condition, reduce spasm, and manage phantom limb pain.

• PHYSICAL THERAPY
• MASSAGE
• CHIROPRACTIC
• ACUPUNCTURE

Areas of the body not directly related to the amputation (compensatory structures) are tasked with super functions – from the spine to abdominal muscles to limb ligaments. The above listed therapeutic modalities are often employed for the surrounding body parts that suffer muscular tightness, stiffness, and spasms. Physical therapy, chiropractic care, massage, and acupuncture can help alleviate these conditions, reduce swelling, improve circulation and promote healing.  A good amputation lawyer will speak with all care providers to get a holistic picture of a client’s health and welfare.

Botulinum Toxin A Injections: In one study that had 20.2 % of amputees participating because of an accident, the administration of botulinum toxin A was shown to effectively reduce phantom pain as measured on the Neuropathy Pain Scale. This is vital for recovery, as about one fourth of persons with a trauma-related amputation reported ongoing severe problems with the residual limb, including phantom pain, wounds, and sores.

Nerve Blocks: A nerve block, depending on the type, uses medicine or sometimes even chemicals or heat injected around a nerve or group of nerves to stop pain messages coming from that part of the body. The medicine can be pain-relieving and anti-inflammatory, and may be needed not only in the residual limb, but in the lower back, for example, if the spine is out of alignment from compensating for the lost limb. Depending on how the individual responds to the treatment, pain relief from nerve blocks can be very short-lived or last up to 6-8 months. However, they are always temporary, as the nerve grows back as part of the body’s natural healing process, and begins sending pain signals to the brain once again.

As can be gathered by the multiple phases of treatment required, the many practitioners and providers involved, and the numerous healing modalities available, future economic losses can run into the millions just for ongoing care. Understandably, amputees may be resistant to trying new or additional modes of therapy, as they have often undergone extensive “unpleasant” interventions both pre- and post-amputation surgery, but with healing comes improved quality of life, which is the main goal for our clients.

Economic Losses in Amputation Cases: Lost Wages

Wage Loss: Depending on the profession of the injured person, an amputation can restrict the ability to return to regular employment. As a result, an amputee may suffer from reduced income as well as a lifetime of future wage loss, or what the law calls “Diminished Earning Capacity.” Our experienced amputation lawyer, Peter Anderson, works with specialized vocational rehabilitation experts and forensic economists to determine the amount of future financial losses. Of course, financial cost pales in comparison to the traumatic personal experience of losing a limb. The change in quality of life associated with the loss is devastating for most people. Despite having a prosthetic that helps restore mobility, recovery can be limited and ability to participate daily activities may be truncated. This is where non-economic damages come into play.

Amputees’ Non-Economic Losses

Backed by an experienced Colorado amputation lawyer, our law firm has a unique knowledge of symptoms experienced by amputees and how these will impact the amputee over the course of their life. As a result, the “non-economic damages” (the monetary amount used to compensate a person for their personal loss) is very substantial.

Pain & Suffering: Neuromas, which are inflamed peripheral nerve bundles that often form due to injury, frequently develop after an amputation. New studies point to neuromas as sensitive to electromagnetic fields (EMFs) from cell phone towers, power lines, and other transmission devices. Neuropathic pain from this source is only beginning to be understood, especially in amputees. There was previously plenty of anecdotal evidence on this phenomenon, but researchers are working to prove issues of radiofrequency electromagnetic energy hypersensitivity, including how it relates to amplified phantom limb pain experienced by amputees doing something as ordinary as being close to a cell phone tower. One survey of amputees reported that in the previous four weeks, almost all (95%) of respondents had experienced one or more types of amputation pain, whether it was phantom limb pain (79.9%), residual limb pain (67.7%), or back pain (62.3%). Unfortunately, the level of pain reported was also extremely high, rated “severe,” at 7-10 out of 10. Due to the intensity and duration of this pain, it is fair to say that amputees will most likely experience chronic pain as a result of their amputation, “regardless of time since amputation.” This means that an amputee can still be dealing with chronic pain years later, and possibly for the rest of their life. A thorough amputation lawyer will factor lifelong pain management such as medication and physical therapy into the case.

Emotional Status: There is not just one specialist who facilitates an amputee’s healing journey. Practitioners such as physical medicine doctors, physical therapists, occupational therapists, and rehabilitation psychologists all work together to restore health and independence, as well as addressing any associated mental health crises including post-traumatic stress disorder (PTSD). PTSD symptoms vary for each person but can range from flashbacks to overall emotional numbness…anxiety, exaggerated startle reactions, nightmares, insomnia, and extreme avoidance of reminders of the trauma. PTSD appears to be more common in amputees following…accidental injury. Approximately 41% of amputees are at risk for anxiety (including PTSD), depression, substance use disorder, strained relationships and reduced quality of life. Anxiety is characterized as excessive worry but symptoms may present as restlessness, insomnia, difficulty concentrating, fatigue, and muscle tension. For amputees this may be heightened by “mutilation anxiety,” stemming from changed body image after the amputation, with men and women experiencing and manifesting the anxiety in varied ways. Depression is also a common finding, with 28.7% of amputees suffering significant depressive symptoms, per a John Hopkins University study. Depression (lasting sadness, loss of interest, decreased energy) can often lead to divorce or separation, living at the near-poverty level or suffering co-morbid conditions (bodily pain included).   Physical activity is often a recommended course of action for battling depression; however, the headwinds for physical activity are substantially higher for amputees. Many face environmental barriers – policies, physical/structural, work/school, attitudes/support, and services/assistance subscales – that impact participation in exercise. Simple accessibility issues can be instantly limiting.  In an empirical study published by the International Journal of Qualitative Studies on Health and Wellbeing, survey participants pointed to removal of barriers erected by the healthcare and insurance systems. They felt insurance companies had the power to deny mobility devices based on arbitrary or ableist understanding of how they would be used. The emotional toll, compounded by insurance company battles, falls into generalized grief at the loss, feelings of isolation, body image, disability stigmas, and more. No one should go it alone; we acknowledge the losses faced by our amputee clients and work to restore their lives however we can.

Scarring & Disfigurement: Scars are a natural part of the healing process, but no one wants the constant reminder of traumatic injury they suffered. Scars are often a direct result of the accident itself, immediate surgeries to save the limb, subsequent amputation surgery at a later date or revision surgeries to alleviate ongoing limb pain. Amputees may experience a particular type of scarring known as contractures, which occur “when a large area of skin is damaged and lost…causing a tight area of skin.” Not only does the amputation cause loss of mobility and balance, but the decrease in skin size due to contractures “can then affect the muscles, joints, and tendons, causing a decrease in movement.” There are treatments available for scarring, such as steroid, collagen, or cortisone injections, cryotherapy, or pressure therapy. Unfortunately, more surgery may eventually be necessary, such as tissue expansion, skin grafts, or laser surgery. Due to the traumatic nature of a catastrophic crash, an individual’s body may experience a “permanent structural deviation from the normal shape, size, or alignment, resulting in a deeply and persistently harmed appearance medically,” or disfigurement. Like scarring, the impacts on the person are physical, mental, and emotional, and research indicates that the experience of disfigurement is multifaceted, involving individual and societal factors. While we cannot influence societal perceptions of a changed appearance, we can support our individual clients navigate recovery by considering not only their physical needs, but their mental and emotional health as well.

Physical Impairment Losses – Limb Amputation

It may be surprising to know that under Colorado law, there is no widely accepted definition for physical impairment losses. As a local amputation lawyer, Peter Anderson has found one description resonates best: “physical impairment” is an alteration of an individual’s health as assessed by medical means. It is a loss or material deficiency of health, any physical function or capacity, or a detriment to the body.  In the simplest of terms: physical impairment affects a person’s body, resulting in a loss or reduction of the way their body functions. Physical impairment can manifest as chronic pain, restricted mobility (reduced strength/coordination), impaired sensory capabilities and/or inability to perform tasks or return to a normal lifestyle. This isn’t limited to just amputees, as people with severe neck, spine, and head injuries also suffer physical impairments. However, the presentation and experience for an amputee is unique – they suffer physical losses and changes quite unlike any other type of injury.

Chronic Pain: Phantom limb pain, reported among 42.2% to 78.8% in amputees, is but one of the main forms of chronic pain experienced by amputees.  The list goes on as reliance on one limb can cause significant joint pain in remaining limbs and the joints supporting the prosthesis. Additionally, back/spine misalignment can cause persistent pain as the body tries to compensate for the loss; studies suggest three main pathophysiological mechanisms for chronic pain: amputation site, the brain, and the spinal cord. Afferent neurons, also called sensory neurons, bring information from the outside world through the spinal cord into the brain. Amputees can experience chronic “deafferentation pain,” which results from complete or partial interruption of afferent nerve impulses at the amputation site. They may also suffer varying degrees of sensory loss and other abnormal sensory phenomena, such as allodynia, which is a type of nerve pain (often at the amputation site) that causes extreme sensitivity to touch, making prosthetic use sometimes unbearable. Sensitization is also a common phenomenon, with the brain interpreting the pain signal more frequently, intensely and longer lasting. Many signals are sent to the brain, including touch, temperature, movement, position and vibration that are all being interpreted by the brain as pain. Researchers are also considering other changes at the brain level as contributing to chronic pain, such as the concept of “neurosignature,” which refers to the patterns of activity generated within the brain that are continuously being updated based upon one’s conscious awareness and perception of the body and self. The deprivation of various inputs from the limbs to the neuromatrix causes an abnormal neurosignature to be produced. Cortical reorganization, where brain mapping is affected by loss of limb, has been found to be directly related to the degree of pain and the size of the deafferentiated region. The times it takes for the brain to reorganize itself may also help to explain why chronic pain onset can be years after the amputation. With all of these potential causes and symptoms of chronic pain for an amputee, it is important to take the whole person approach to treatment and recovery to minimize the impacts of physical impairment losses on their overall quality of life.

Restricted Mobility (Reduced Strength/Coordination): Things that able-bodied people might not notice, such as soft or uneven ground, steep inclines, or even the weather are experienced by amputees as additional challenges that cannot always be anticipated or avoided. If a fall results from interacting with the environment, there is risk of further injury to the body and remaining limb, as well possibly not being able to get up again without help. Considering the physical impairment definition of limiting a person’s physical capacity to move or coordinate actions, an amputee’s experience certainly fits into this category. Given that lower-limb amputee quality of life is significantly associated with mobility,” it is crucial to consider that the amputation affects walking speed and distance, balance, muscle strength and functional performance, as well as energy expenditure. In addition, the residual limb can experience muscle atrophy, with muscle volume reducing by 17% to 35% in the first six months post-amputation in people with lower leg amputation. Changes in gait are almost inevitable, and the amputee may favor the intact limb while the residual limb experiences decreased joint moment, power and ground reaction force.

Inability To Perform Tasks: A physical impairment substantially limits one or more of a person’s major life activities. While amputees are certainly not excluded from returning to their pre-accident lifestyle, it is a long journey back to that point. Some may never achieve the same level of activity as before, or experience constant pain while engaging in their regular life pursuits. Basic everyday personal routines such as bathing, dressing, and eating can present challenges for amputees; many must go through a re-learning process on how to perform everyday tasks in inventive ways (both with and without their prostheses).  Many techniques have been perfected that help amputees with daily living at home; however, many of these tools are not portable for travel.  This means that some amputees may not be able to return to their previous employment or hobbies, as the accommodations provided may not adequately enable them to participate. An experienced amputation lawyer will take all of these physical impairment losses into consideration during case analysis, settlement negotiations and, if required, trial presentation.

Hiring A Colorado Amputation Lawyer

Amputation cases are some of the most severe encountered in the practice of personal injury law. We acknowledge the impact that loss of limb has on a client, and we work to help our clients obtain full/fair compensation for their losses. We recognize that money doesn’t make up for the life-altering injuries, but that is our justice system. And we want the justice system to do right by our clients.

Recent national amputation verdicts have evaluated double double-leg amputations as worth $95 million; another jury awarded $34 million for a single leg below-the-knee amputation for a previously very able-bodied individual; in California, a motorcyclist was awarded nearly $24 million after his leg had to be amputated following a collision with the defendant trucker (the judge found the defendant fully liable for the accident and awarded plaintiff $22.5 million for past and future medical expenses, and his wife $1.2 million for loss of consortium).  There are plenty of similar examples in Colorado as well, from workplace ATV accidents and motorcycle crashes resulting in limb amputation and disfigurement.

Due to the gravity of amputation injuries, you need to hire an amputation lawyer and law firm that have experience with on-road accidents and severe trauma.  You will need to work with attorneys who understand some of the medicine and work with local treating doctors and experts in the field. We hire and rely on amputation specialists such as orthopedic surgeons, physical medicine specialists, prosthetists, accident reconstructionists, life care planners, economists and more.

As one of the few dedicated trial law firms in Colorado, The Law Offices of Peter M. Anderson takes a small handful of serious auto, truck, and motorcycle crashes to court each year.  We are not a high-volume Denver law firm or national law firm mill that churns out hundreds of cases; we are a small, specialized group committed to only a handful of catastrophic cases each year – and amputation cases most definitely fall into this category. Please call us today to discuss your amputation/disfigurement injuries; we can travel to meet you and discuss the merits of your case.  Call any time (303) 444-1505 for a free consultation.