A large proportion of patients admitted to the Accident and Emergency Departments report an injury resulting from some kind of trauma.

In such cases doctors usually have two diagnoses to consider:

  • Soft tissue injury (bruising, sprain, ligament damage, tendon damage)
  • Fracture

When a fracture is suspected, an x-ray should be taken. Claims can arise when a doctor has not properly examined a patient and decides that they have sustained a soft tissue injury without sending them for an x-ray.

Claims can also arise when an x-ray is not examined properly, a fracture is missed or misreported or the patient is not called back for review of the radiology.

Anyone considering making a claim should, however, be aware that it is not always possible to detect a fracture on an x-ray. Subtle hairline fractures of very small bones can be difficult to detect. There are also areas of the body where x-rays do not always produce clear images. In addition, bruising and swelling can also cloud an x-ray, making it difficult to interpret accurately.

Although some initial failures to detect fractures can be excused as reasonable, there is commonly a duty to follow up an injury where an x-ray was inconclusive. After a few days, once any swelling subsides it is often easier to detect a fracture. Failure to follow up a patient’s injury or provide appropriate advice such as ‘return if the injury is still causing pain’ can give rise to a claim.

The effects of a misdiagnosed fracture can range from a few additional weeks of pain to a complete failure of the bone to heal (unite). A broken bone left untreated can also restrict the blood supply to local tissue and if a muscle is not supplied with blood carrying oxygen, it will become damaged and start to die. This is called Avascular Necrosis.

Scaphoid Fractures

Scaphoid fractures (a break in the small bone on the thumb side of the wrist) are notoriously difficult to diagnose; specific views need to be taken on an x-ray if a scaphoid fracture is suspected. They are also renowned for not always showing up on an x-ray if it is taken immediately after the incident. It is usual for a doctor to arrange a follow up appointment within 1 – 2 weeks for a further xray. Failure to do so may be indicative of negligent treatment.

A Scaphoid fracture will be suspected if the doctor carries out a number of tests/examinations on your wrist. The classical sign is tenderness in the anatomical snuff box (the radial aspect of the dorsum of the wrist). They should also try and get you to hyperextend your thumb to examine the tendons and see whether they become obvious. In addition they can look for tenderness of the scaphoid tubercle by extending your wrist with one hand and putting pressure on the scaphoid tuberosity at the proximal wrist crease with the other. If there is no tenderness then a scaphoid fracture is unlikely.

If the doctor did not perform these tests and this led to a delay in diagnosis and treatment of your scaphoid fracture, then you may have a claim and will need to discuss matters with our specialist team. A delay in diagnosis can cause Avascular Necrosis (as mentioned above), scaphoid non-union/delayed union, reduced grip strength and reduced range of motion and may increase the likelihood of you developing osteoarthritis in the joint.

If you believe you have a claim after a misdiagnosis you should contact a member of our medical negligence team for an initial consultation free of charge.


RELEVANT CASES

CLAIMANT v PENNINE ACUTE HOSPITALS NHS TRUST

Claimant presented to the Trust after injuring his right knee. The Trust carried out an x-ray which revealed no fracture and the Claimant was sent home with pain killers.

The Trust Casualty Officer failed to examine the Claimant’s quadriceps tendon and failed to diagnose the complete rupture of the quadriceps tendon of his right knee, despite the significant pointers to the nature of this injury. Had the correct diagnosis been made, the Claimant would have been referred for urgent surgery to repair the ruptured quadriceps tendon. These injuries are best treated within a few days of the injury but as a result of the failed diagnosis, surgery was delayed for 5 weeks. It was fortunate for the Claimant that the surgery was still able to obtain a satisfactory repair of the quadriceps tendon, though the Claimant’s subsequent recovery became more difficult than it would have been had surgery been carried out promptly.

Out of court settlement. Damages - £3,250.


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