"At your request I examined this lady on the 1st. August. She told me she was struck by a car as a pedestrian in Hobart on the 12th September, 1985. She sustained a transient loss of consciousness. She was in the Royal Hobart Hospital for about three days after being injured. She told me she had an undisplaced skull fracture. She said she also noticed backache at the time together with pain in her lower legs where the car had apparently run over her.
The back pain and discomfort have persisted and she often finds it necessary to sleep in chairs. She told me she had a poorly healed wound in the lower left leg which later became infected.
She told me she used to be a very active person with a home gym system and used to enjoy a great deal of walking. She now gets variable backache after activity, including much walking. She also suffers from it in cold or wet conditions. Her gardening has been restricted as this also causes backache.
She said she cannot travel long distances in a car as she needs to stop and get out and move around to relieve backache. She is currently taking no medication and believes her back symptoms to be fairly static. She said she cannot sit at a sewing machine for long periods as she used to do before, having been a very keen dressmaker for many years. She denied any back problems before the accident.
She said her lower legs ache if she walks much. She finds the lower legs and ankles tend to swell later in the day since the accident and ache more. She mentioned that she was concerned about their cosmetic appearance. She said she had to keep the sun off the scars which ached in cold weather, particularly on the left side. She said she wore supphose to control swelling.
EXAMINATION:
She walked with a normal gait without a limp. I noted a ten centimetre scar on the lateral side of the left lower leg and this scar was about three centimetres wide approximately; it was unpleasant in appearance and was tender. There was a four centimetre lesser scar on the antero medial aspect of the right lower leg. I noted some swelling in the soft tissues just above the ankles, more marked on the left side. Range of ankle movement was full.
There was tenderness in the lower lumbar spine with some restriction of lumbar movement particularly extension. Straight leg raise however was not limited and she was neurologically normal. X/ray of the lumbar spine showed some decrease in the normal lumbar lordosis indicating muscle spasm and minor degenerative change in the central lumbar spine not inconsistent with her age.
OPINION:
Mrs McCreary has sustained soft tissue damage to the lumbar spine with probable damage to a lower lumbar disc, in my view. I believe her lumbar spine is permanently weakened to an extent and she will continue to be troubled by variable backache with considerable activity or prolonged sitting. This will lead to continuing handicaps with activities which she enjoys such as sewing and gardening.
I do not consider future surgery will be indicated. She may at times need to take anti-inflammatory medication. She might find in the future some help from wearing a supportive type of corset.
She has sustained crush injuries to the lower legs which has left her, particularly on the left side, with a rather unsightly scar. I would certainly accept that this has had the effect of causing some distal swelling there later in the day and I believe this too will be permanent. I do not think there is anything really that can be done about this condition. She is not likely to develop arthritis as a result of these injuries. If anything I would expect the legs to gradually improve over the next year or two however. I would suggest she should probably be considered to have a ten percent disability of the left leg and perhaps a five percent disability of the right due to these soft tissue injuries. I note she had wound breakdown and infection before on the left side and I would not recommend cosmetic surgery to improve the appearance here as I believe there would be an increased likelihood of such complications ensuing again."