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Missed fractures

Hospitals can miss the diagnosis in accident and emergency departments and fracture clinics.

Missed fractures

A patient has a fall and goes to the accident and emergency department of the local hospital. There may be an x-ray taken, or maybe not.

The patient is reassured that it is just a sprain, though it may take time to heal and be painful for some time.

Weeks later, the joint is still swollen and painful: perhaps the GP sends them back for an x-ray. It is found that the sprain was in fact a fracture.

If x-rays were taken at the start, they may be checked and found to show a fracture which had been missed. In circumstances like these, failing to x-ray the joints in the first place or missing the fracture on the x-ray may be hard for the hospital to defend. The real issue will be what would have happened if it had been picked up straight away. Perhaps it would have been slow to heal in any event? Perhaps no surgery will be needed despite the delay? If it can be proved that on balance of probability, the outcome is worse than it would have been with prompt diagnosis and treatment, then there is a probable claim for medical negligence.

The outcome can be very serious too - it may involve long-term pain and an inability to use the joint. The only solution for the pain may be an arthrodesis, to stiffen the joint, rendering it pain free but not very useful. And if you need a strong wrist for your job, whether driving, or moving loads, for example, the impact on earnings ability may be very serious.

The classic case of a missed fracture is the scaphoid - not easy to see on the initial x-ray, so much so that checks a week or so later are often recommended.

In one case a community nurse in her sixties was dismissed as worrying about nothing - in fact there was a missed fracture. Unable to drive, she had to retire early from a job she loved. We recovered compensation for her loss of earnings and her pain and suffering for the extra period of pain she had suffered.

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