Undiagnosed Fractures
What is it?
Self-evidently, an undiagnosed fracture is just that. Virtually any fracture can go undiagnosed, but, as you would expect, some fractures are easier to miss than others. Fractures to bones in the wrist and particularly scaphoid fractures can be difficult to detect on initial presentation at Accident and Emergency (A&E), even assuming that an x-ray examination is performed. However, this is by no means the only area of misdiagnosis.
How do we investigate the claim?
Typically, undiagnosed fracture claims arise from an initial assessment at A&E, at which either x-rays were not performed, or standard procedure for fracture diagnosis was not followed, or both. Because the correct diagnosis has not been made, referral to the Orthopaedics department for treatment is unlikely to happen, at least in the first instance. It is therefore quite possible that a patient who has been unlucky enough to have been misdiagnosed in the first instance will spend a good few further months in agony before the mistake is picked up, by which time irreparable and avoidable damage may well have been done. Unfortunately, it is frequently also true that the longer a fracture is left, the more likely it is to need surgery.
In order to win a claim involving an undiagnosed fracture, we need to prove that contemporaneous clinical guidelines were not followed (breach of duty), and that if they had been, then on the balance of probabilities the condition would not have developed (causation). It follows from this that we need to evaluate the patient's history, determine whether the fracture was there at all times, whether it could or should have been noted on x-ray examination, and also whether the relevant guidelines were followed.
In our experience, these claims often require at least two experts. Because the condition can stem from trauma and its treatment, patients who have suffered a misdiagnosed fracture will frequently have been treated either in an A&E, and subsequently Orthopaedics hospital departments. Consequently, it is usually necessary to instruct independent experts in the field of either or both A&E medicine, and Orthopaedics, to help us assess whether there has been a breach of the hospital's duty of care. We would normally expect an Orthopaedic expert to comment upon what damage was done, and upon whether this could have been avoided with more expeditious referral to a specialist orthopaedic unit. We would then need to assess the patient's present condition and prognosis. Again, it is likely that this exercise would in the first instance be undertaken by an Orthopaedic specialist.
As with any clinical negligence claim, misdiagnosed fracture claims can be extremely complex - although proving the case can well hinge upon one or two x-rays: if it transpires that there was a break which was clearly visible at the time, but which wasn't picked up, then the case may well succeed.
Contact
Angelina Rigby Head of Clinical Negligence
Steve Duddell Partner
Nye Moloney Trainee Legal Executive
Jane Beresford-Huey Assistant
Angela Konstanz Assistant
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