Client case studies: delay in diagnosing fractures

Failure to Diagnose Fractures FAQs

• What types of fracture can be misdiagnosed?

  Any type of fracture can be misdiagnosed.

  Sometimes, fractures in the feet or ankle can be missed due to the similarity of symptoms with a sprained ankle.

  An x-ray may not be carried out on the sprain and this may result in missing an underlying fracture. When there is no evidence of any trauma, there could be an undiagnosed condition which results in a fracture.

  Osteoporosis is one such condition. If A&E do not pick up on this condition and order further tests, the fracture diagnosis may be delayed or even completely missed. If a fracture is missed and the correct treatment not carried out within an acceptable timescale, the implications can be significant. For example, if the fracture needed to be secured with pins and wasn’t, there could be lasting problems which affect you for some time afterwards.

  If you have any comments to make about this article or would generally like to discuss a potential medical negligence claim, then please contact us on 0117 239 8012 and we will put you through to a member of our specialist medical negligence team.

• Delayed diagnosis of broken fingers – can I sue the hospital?

  Whilst there is no straightforward “yes or no” answer to this question, our Medical Negligence specialists would say “probably, yes”.

  Cause of fracture

  The Emergency Department at a hospital ought to take a full history of any injury presented to them, including how it was caused.This information should give the treating hospital staff some indication as to whether or not there is a likely fracture. For example, fractures to the fingers often occur as a result of a punching injury or as a result of a fall.

  Failing to spot fractures in X-rays

   X-rays are carried out regularly in Emergency Departments up and down the land. The first person to review the x-rays will often be a junior member of medical staff.

  Whilst these members of staff will have been trained on how to read and interpret x-rays, their lack of experience can lead to fractures being missed.

  A second opinion is required

  Hospitals should allow for the possibility of missed fractures in their risk assessment process by ensuring that the same x-rays are immediately reviewed by a senior doctor in the same department or by a Radiologist. Sometimes, such a review might not take place for a few days but this is generally acceptable.

  If a junior doctor has been found to miss a fracture, the patient can be recalled and appropriate treatment provided without the patient’s recovery being affected to any significant degree.

  When do medical negligence claims occur?

  Problems arise when fractures are missed by the junior doctor, and the x-rays are then not reviewed for a week or more, and/or even when they are reviewed the senior member of staff also misses the fracture(s).

  If the fractures were spotted in the end, but there was a delay, a medical negligence claim would probably succeed if the delay was clearly more than a few days (roughly 3-4 days).

  If the fracture was missed but then spotted and the patient recalled within a few days, although technically there had been a breach of the duty of care owed by the hospital to its patient, the effect of that breach of duty is so minimal that a compensation claim would not be feasible.

  Failing to take X-rays

  If x-rays were not taken by the hospital, then the claimant is likely to be in a stronger position with regards to liability (depending upon the history given to the Emergency Department at the time).

  How broken fingers and hands differ

  Injuries to the fingers/hand are particularly time-sensitive. The longer the delay and the more severe the fracture(s) is, then the more likely it is that the patient/client will be left with long term and even permanent symptoms in the hand.

  The greater the impact to a person’s domestic and working life, the more the claim is likely to be worth.

  Long term symptoms could include pain and discomfort in the fingers over and above any pain and discomfort which the patient would have experienced anyway; deformity in the finger(s) itself etc.

  If you or someone you know has experienced a delay in having a fractured finger(s) or any other fracture diagnosed, please contact our Medical Negligence team on 0117 239 8012.

• I have been told that I have injured the Lisfranc joint in my foot. What is this?

  The Lisfranc joint is in fact made up of a number of joints in the foot (otherwise known as the tarso-metatarsal joints) rather than being one distinct joint on its own. It is the Lisfranc joint which helps to provide the arch in the foot and it also provides movement so as to assist us if, for example, walking on uneven ground. 

  If you have simply been told that you have a Lisfranc joint injury then this is likely to mean that you have fractured one or more of the tarso-metatarsal joints. These joints can be found, in basic terms, where the toes come together with the rest of the foot. 

  It is possible, however, for a Lisfranc joint injury to be a soft tissue injury rather than an actual bony injury (ie a fracture) and so if you have not had this confirmed by your treating doctors then you should seek this confirmation as a matter of urgency. 

  These injuries are not particularly common and are also not necessarily straightforward to diagnose. A fracture of the Lisfranc joint is often best demonstrated on what is called a “weight bearing x-ray” – in other words an x-ray where the patient is standing up and putting his/her weight onto the foot. Such x-rays may not, however, always be taken in hospital, even if such an injury is suspected, due to the amount of pain that the patient is likely to be in at the time. 

  Once the initial swelling from any Lisfranc joint fracture has gone down (which can take several days) then a CT scan should be taken of the confirmed/suspected fracture and this will show in more detail the level of displacement within the Lisfranc joint. At that stage your treating doctors should, as swiftly as possible, make a decision as to whether surgery on the foot is required. Generally speaking, if the fracture(s) is undisplaced (i.e. the bone has stayed in its normal position) then surgery is unlikely to be required. However, if there is displacement then this will almost certainly need to be treated surgically and held in position with screws. 

  If the damage to the Lisfranc joint is very severe then fusion surgery may be required. This would be a last resort however, as whilst such surgery is likely to cure the pain which the patient is experiencing, the fusion itself will impact upon the movement of the foot in the long term. 

  Statistically Lisfranc joint fractures are highly likely to lead to the development of arthritis in the foot later on, although there is a decent chance that this arthritis will not lead to further symptoms of pain. 

  Problems can come where there is a missed or delayed diagnosis of a Lisfranc joint fracture, particularly a displaced one, because a delay in appropriate treatment of such an injury will potentially have an impact upon the function of the foot in the long term and can quite possibly also lead to long term symptoms of pain for the patient which could otherwise have been avoided.   

  If you or someone you know has experienced a delay in having a  fracture diagnosed, please contact our Medical Negligence team on 0117 239 8012.
  

• The hospital missed my wrist was broken - what are my options and can I claim loss of earnings?

  Q: A few months ago I fell and hurt my wrist. The hospital said it was just a sprain but after many months of being in pain they decided it was actually fractured - something they didn’t notice at the initial x-ray. I’ve had to miss work because of it – what can I do?

  A: Failure to diagnose fractures is probably more common than you may think, but there are options to help you claim back compensation, including loss of earnings. A failure by GPs and hospital doctors to make a correct diagnosis at the appropriate time represents one of the most common areas of medical negligence claims. I also see cases of serious illnesses being missed such as cancer, appendicitis and kidney failure. Whatever the scenario, the impact of this failure to diagnose is often devastating, but there is help available to try and make life easier. 

  For help and advice on Medical Negligence claims call 0117 239 8012.