Delay in diagnosis of wrist fracture
John fell on to his outstretched right hand as he was playing football. He attended the Accident & Emergency Department and following an examination, was advised that there was no bony injury. Tubi-grip was applied, and he was given painkillers and RICE (Rest, Ice, Compression and Elevation). No x-rays were performed.
12 months later, the pain persisted, and John returned to his GP and eventually an x-ray was performed. This confirmed a fracture of the scaphoid – the largest bone beneath the thumb and above the wrist. An arthroscopy and MRI scan followed 10 months later, which revealed a vascular necrosis (bone death through lack of blood supply) at the site of the injury and displacement of the lunate, the bone next to the damaged scaphoid. He underwent a partial fusion of the wrist and whilst there was some initial reduction of pain, stiffness, etc., John was required to undergo a total wrist fusion which resulted in no wrist motion and reduced grip strength.
Damages were sought on the basis that the initial diagnosis was incorrect. The doctor at the A&E Department failed to check the wrist for movement and pain and failed to request a series of x-rays, resulting in the fracture being missed.
The case settled for £50,000 which included a payment for loss of earnings.
Failure to diagnose a brain tumour
Claire suffered from tinnitus and head pains and following a visit to her GP, she was referred to the Ear, Nose & Throat Department. An MRI scan confirmed the presence of a Schwannoma tumour of the nerve which connects the ear to the brain, but then concluded the scan was normal. The ENT Consultant had misread the conclusion and not the detailed report, following which Claire was discharged and no follow-up arrangements were made.
Claire’s symptoms continued and she returned to her GP who referred her for further investigations. Her hearing had deteriorated, and it was noted that there was an error on the reporting of the MRI scan which was confirmed. A month later, Claire was referred to hospital and underwent repeat scanning which showed an increase in the size of the tumour of 4mm by 5mm. Subsequently, she underwent gamma knife radiosurgery to remove the tumour.
A claim was made against University Hospitals Coventry & Warwickshire NHS Trust for failing to diagnose the Schwannoma on the MRI scan. The delay in diagnosis meant that the hearing loss was no longer amenable to treatment with a hearing aid and Claire continued to suffer with symptoms of dizziness, head pains, and balance problems, resulting in her not being able to work. The Trust accepted negligence but failed to accept that the delay caused all of Claire’s ongoing problems. The matter settled for £425,000.
Failure to treat wrist fracture effectively
Elizabeth fell down the stairs at home and was taken to Hereford Hospital, A&E Department, where she was x-rayed. She was diagnosed with fractures to her left wrist and right thumb. The wrist was manipulated and plastered in a back slab and her thumb on the right hand plastered. Several weeks later Elizabeth attended the outpatient fracture clinic when x-rays were taken which showed a gradual deterioration with the fracture starting to displace. No further treatment was recommended. The plaster on the right hand was removed and a few weeks later the left plaster was removed. X-rays were taken and she re-attended several months later when she was advised her recovery was reasonable and discharged.
She attended physiotherapy for 4 weeks but unfortunately her condition did not improve with the wrist remaining painful, stiff, and weak. She was seen by a Rheumatologist who referred her for physiotherapy and later x-rays were taken. She was advised by the physiotherapist that she was unable to assist due to the position of her wrist. She was referred to an Orthopaedic Consultant who advised that the wrist was displaced and that she would need further surgery, which would involve fusing and plating.
The Trust admitted negligence in failing to recognise that the fracture was displaced at the outset and indeed, on all the follow-up appointments. The expert advised that remedial action should have been taken in the form of manipulation and stabilisation by insertion of k-wire. If this had been carried out, the wrist would have healed normally. As a result of the failure to treat the displacement in a timely manner, Elizabeth is left with a painful weak wrist but decided not to proceed with the wrist fusion for the time being. The case settled for £40,000.