Our clinical negligence team has settled a substantial claim against the Royal Surrey County Hospital in Guildford for the failure to diagnose a shoulder fracture, resulting in lifelong injuries for our client.
The claimant, a keen cyclist aged 34, fell from his bike on a charity cycle ride, fracturing his thumb, clavicle (collar bone), and humeral head (shoulder) in the fall.
He was taken by ambulance to the local A&E where initial X-rays were performed. The thumb and clavicle fractures were diagnosed, but despite the shoulder fracture being visible on the X-rays, this was not picked up in the radiology report. However, he was then referred to the Royal Surrey for further investigations.
On arrival at the Royal Surrey, more X-rays were taken, and again the shoulder fracture was visible. The radiology report suggested a potential abnormality which would benefit from additional imaging, but no further action was taken by the orthopaedic team to investigate, by way of a CT scan or alternative views. The orthopaedic team repaired the thumb and clavicle, and the claimant was discharged.
Following his surgery, the claimant attended a number of orthopaedic clinics, continuing at each appointment to complain of pain and stiffness in his shoulder. Repeated X-rays were taken, all clearly showing the shoulder fracture, but this crucial abnormality was not picked up until eight months after the initial event. Instead he was sent for physiotherapy and injections into the shoulder joint.
By this stage, the fracture was no longer amenable to a standard repair, and a humeral head graft was attempted, but failed. The claimant was then referred to a tertiary centre where he underwent a shoulder replacement.
Unfortunately, shoulder replacements are not as technologically advanced as more common replacements such as knee or hip replacements. The claimant has very limited range of movement in the arm, and suffers ongoing pain. He is likely to need two further shoulder replacements in his lifetime. He is also likely to face a scenario in the future where the third replacement wears out, but he will be unable to undergo further surgery. At that point, he will essentially lose the use of his right arm. He is considered disabled in a work context, and his employer has had to make adaptations to his day to day employment which had previously involved significant ‘hands on’ work with machinery. We pursued a claim on the basis that the Royal Surrey had failed to recognise and act on the shoulder fracture that was clearly visible in the X-rays. The Royal Surrey accepted that it should have acted on the findings, and that had it done so, it was likely that the claimant would have retained around 80% of the function of his shoulder. Expert evidence on the claimant’s future deterioration was fairly complex, and with that information, evidence on future care, and his potential loss of earnings and pension was obtained. The claim was settled for £600,000, which will give our client significant security for the future.
This case demonstrates that even if an obvious abnormality is picked up on an X-ray, it is vitally important that the whole X-ray is examined to identify any further problems. The missed fracture was compounded by the apparent ‘confirmation bias’ of successive surgeons, who did not consider alternative explanations for our client’s ongoing pain until it was far too late.