Case Study: Failure to diagnose the full extent of an ankle fracture

Our client suffered an injury to his right ankle as a result of a non-fault road traffic accident. Our client’s ankle was immediately painful and by the time he attended the A&E department of his local hospital the ankle was also significantly swollen. 

The hospital carried out x-rays of our client’s ankle which revealed a fracture of the ankle bone (otherwise known as the Talus) which appeared to be comminuted (i.e. the bone was in more than two pieces). The ankle was placed in a plaster cast and our client was referred to the hospital’s Fracture Clinic, with the appointment taking place less than one week later.

The hospital radiologist who reviewed the initial x-rays reported that the fracture did not extend into the talonavicular joint (this sits in front of the ankle joint and basically allows the arch of the foot to move properly when walking).

At the subsequent fracture clinic appointment an Orthopaedic Surgeon reviewed the previous x-rays and arranged for a CT scan of the ankle/foot to be done. However, the CT scan did not take place until well over two weeks later and it showed that the fracture was significantly more extensive than had first been diagnosed.

This failure to properly identify and report on the nature of our client’s ankle fracture, and the subsequent lack of urgency in arranging and interpreting a CT scan led to our client suffering a mal-union of the ankle bone, and by the time our client was seen by the hospital’s foot and ankle specialist approximately seven weeks after the road traffic accident, the opportunity to surgically repair the fracture had passed. As a result, our client ultimately had to undergo a fusion of the ankle joint which would otherwise not have been needed until, according to the medical evidence which we obtained, approximately five years later.

A Letter of Claim was sent to the hospital Trust and shortly thereafter the Trust admitted negligence and some causation (i.e. the extent to which the negligence caused our client’s symptoms which would otherwise have been avoided).

After further medico-legal and documentary evidence had been obtained and disclosed (both with regard to our client’s injuries and his financial losses) our client’s claim was settled for the sum of £50,000.

This case highlights the fact that even when a fracture is quickly diagnosed by the hospital (which is in the vast majority of cases, though not all) the fracture itself can be under-reported which can then have a “knock on” effect in terms of the patient’s treatment and, ultimately their recovery. In this case we were quickly able to establish, with the help of our expert Radiologist, that the full extent of the fracture had indeed been missed. We then obtained supportive evidence from our Orthopaedic expert with regard to the impact that the negligence had had on our client’s recovery. 

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