Cases: Orthopaedics – Failure to diagnose scaphoid fracture

Clin Risk 2008;14:119-120
doi:10.1258/cr.2008.080006
© 2008 Royal Society of Medicine

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Cases: Orthopaedics – Failure to diagnose scaphoid fracture

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H v Rotherham NHS Foundation Trust


Dr James Wright, Claimant’s Solicitor


Shoosmiths


Mr Guy Opperman, Claimant’s Counsel


3 Paper Buildings, London





Background

Top

Background
The Claimant’s position with…

Progress of litigation

Background to damages

 

On 10 April 2003 the Claimant, who was aged 52 years at thetime, was riding his motorcycle home when he hit a car and cameoff his motorcycle. The Claimant was fundamentally unhurt inthe fall, but the impact did injure his left thumb. The Claimantdid not attend hospital that day, as he wanted to determinewhether or not the injuries to his thumb would spontaneouslyresolve.

The following day, the Claimant still had pain in the thumband wrist, and so he attended the Defendant Hospital. The Claimant’shand was X-rayed and he was told that there were no fractures.The Claimant’s hand was put in a sling, and he was subsequentlydischarged home with general advice and advice as to medication.

The Claimant wore the sling for a few days, and although thepain in his wrist continued, he did not take any time off work,although he did have some difficulty in doing his job, whichinvolved plastics fabrication and sign-making. The Claimanttook Ibuprofen as and when required for any pain.

The Claimant continued to work although he reported a naggingpain in the wrist, which caused him some discomfort when performingcertain aspects of his job.

Some months after the initial accident, the Claimant saw hisGP and physiotherapy was arranged because he also now had aneck pain, and it was thought that the wrist pain may be referredfrom the neck. The physiotherapy did not help in alleviatingthe Claimant’s wrist pain.

In June 2004, because the Claimant’s wrist pain had still notabated, he was referred through his GP for further X-rays, whereuponit was discovered that he had a fracture of the left scaphoidbone and he was referred to hospital for further investigationand treatment.

The Claimant subsequently underwent an operation in December2004 to bone graft and internally fix the unhealed fracture.The Claimant was in a plaster of Paris cast for six weeks. X-raystaken in May 2005 demonstrated that the scaphoid was clinicallyand radiologically healed. The Claimant needed no further timeoff work and he was able to resume his normal occupation withoutdifficulty.

The Claimant instructed solicitors to investigate a claim againstthe Defendant Hospital in September 2004.





The Claimant’s position with regard to breach of duty and causation

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Background

The Claimant’s position with…
Progress of litigation

Background to damages

 

The Claimant’s medical notes, records and imaging films wereobtained and an independent report commissioned from a consultantin A & E medicine. The Claimant’s breach of duty expertin A & E medicine confirmed that the Trust had been negligentwhen they interpreted the X-ray as showing no bone injury, andin failing to refer the Claimant for further investigation andorthopaedic follow-up.

The Claimant subsequently obtained causation and condition andprognosis evidence from a consultant orthopaedic surgeon. TheClaimant’s orthopaedic expert opined that had the Defendantnot misinterpreted the X-ray and promptly immobilized the Claimant’sscaphoid fracture (within a period of one month) then on thebalance of probabilities, he would have stood a 90% chance ofthe scaphoid fracture going on to unite without the need forsurgery. The Claimant’s orthopaedic expert opined that had thescaphoid fracture gone on to clinically and radiologically unite,then as such, the Claimant did not face the risk of developingosteoarthritis in his wrist, or going on to suffer any futurecomplications or deteriorations in the wrist, as a result ofthe alleged negligence.





Progress of litigation

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Background

The Claimant’s position with…

Progress of litigation
Background to damages

 

Protective proceedings were issued. An application was madeto extend time for service of the Particulars of Claim and supportingdocumentation by consent in order that the Defendant could beallowed time to respond to the Claimant’s detailed Letter ofClaim. The Defendants who were being represented by the NHSLitigation Authority did not serve a formal Letter of Response,and instead made an admission with regard to breach of dutyby email but reserved their position with regard to causation.As a consequence, the Claimant served proceedings upon the Defendantwho then instructed solicitors, who in turn filed an Acknowledgementof Service indicating an intention to defend all of the claim.

The Claimant’s and Defendants’ solicitors subsequently liaisedand agreed to a short stay of proceedings, in order that theparties could explore the possibilities of settlement.

The Claimant made a Part 36 Offer to settle his claim for thenet sum of £24,000 plus costs. The Defendants made a counteroffer of settlement in the sum of £18,000 plus costs.Further negotiations ensued and the claim was eventually compromisedon a full and final basis on 29 January 2007 for the sum of£21,000 plus costs.





Background to damages

Top

Background

The Claimant’s position with…

Progress of litigation

Background to damages

 

Although a global settlement was reached, the Claimant’s solicitorsestimated quantum as follows. General damages for pain, sufferingand loss of amenity were estimated in the region of £10,000,on the basis that as a result of the alleged negligence, theClaimant had endured an unnecessary period of pain and sufferingof about 14 months while the scaphoid fracture went undiagnosedand the need to undergo an operative procedure on his wrist,which resulted in a uniting of the scaphoid and obviation ofthe risks of future complications such as osteoarthritis. TheClaimant’s claim for special damages related primarily to aclaim for lost earnings.

General damages: £10,000; January 2007; Total Award: £21,000

Failure to diagnose a scaphoid fracture in non-dominant hand;52-year-old Claimant suffered 14 months’ pain prior to diagnosisand underwent avoidable surgery, no long-term risk of futurecomplications.

Cases: Orthopaedics – Failure to diagnose scaphoid fracture
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Cases: Orthopaedics – Failure to diagnose scaphoid fracture
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Cases: Orthopaedics – Failure to diagnose scaphoid fracture

Articles by Wright, J.

Articles by Opperman, G.
Cases: Orthopaedics – Failure to diagnose scaphoid fracture
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Cases: Orthopaedics – Failure to diagnose scaphoid fracture
Cases: Orthopaedics – Failure to diagnose scaphoid fracture

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