Biomechanics in the Operating Room

Background

After performing laparoscopic surgery, a 30-year-old nurse claimed that his hand extensor tendon ruptured while he was holding an endoscopic camera during the surgery. The injury was allegedly caused by a forceful grasp from a surgeon over 60 years old who suffered from carpal tunnel syndrome. The nurse was involved in a vehicle collision one week prior to the surgery, during which the air bags were deployed.

The plaintiff's mechanical engineering expert involved in the case opined the injury occurred from a localized force through a soft fiber optic cable passing through the dorsal side of the nurse's hand. The plaintiff's medical expert (hand surgeon) opined that the fiber optic cable had nothing to do with how the extensor tendon ruptured, but that the injury mechanism is possible, and compared it to a rugger jersey finger injury during flag football and to a bicep rupture during flexion.

Process

Given the opposing expert claim of a localized force through the soft fiber optic cable, our team of experts conducted a detailed analysis and experimentation with the subject tool and fiber optic cable to determine the plausibility of the injury through the claimed mechanism. Among the tools used during the inspection and analysis were motion capture technology and photo matching techniques to evaluate the upper body postures, force transducer, and tactile pressure sensors. Additionally, our experts performed an extensive literature review to understand all the factors that need to be considered when evaluating hand force exertions and the mechanism of injury for an extensor tendon.

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Results

Explico determined that biomechanical mechanisms of injury for an extensor tendon rupture involves acute traumatic events or chronic injuries. Through our analysis, our experts demonstrated that many factors affect grip strength and pulling/pushing forces, that grasping forces are not localized in only one zone, and that hand movement in this scenario can only be achieved if the reaction forces in extension exceed the external forces forcing flexion. Dr. Rosemarie Figueroa Jacinto testified in state court, and the jury agreed with Dr. Figueroa's testimony, and the claim was dismissed.

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Associated Professionals

Paul Snyder, MS, PE

Managing Engineer

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