Settlement reached for failure to diagnose multiple comminuted foot fractures

We have recently settled a case against an NHS trust for failing to diagnose a fracture of our client’s right foot.

Our 35-year-old client suffered a fall while out running and experienced immediate pain and swelling on the side of her foot. She attended her local accident and emergency department where x-rays were performed of the ankle but not of the foot.

The x-rays were erroneously interpreted as showing no fracture or dislocation and our client was diagnosed as having suffered an ankle sprain. She was discharged with advice to rest and apply ice. She was not provided with any further safety netting guidance about what to do if her symptoms persisted.

Our client continued to experience pain, swelling and significant bruising to the side of her right foot and visited her GP on a number of occasions as a result of her ongoing symptoms, in particular her continued pain on walking and running. Although her foot was noted to be markedly bruised and swollen, she was advised to continue to mobilise and take regular pain relief medication.

At two months post-injury, our client’s symptoms had failed to improve. She returned to her GP and requested a referral to a private orthopaedic surgeon for a second opinion. Upon referral, she underwent repeat x-rays which were suspicious of a Chopart’s injury and an MRI scan was recommended. The results of the MRI scan revealed multiple compressive fractures of the cuboid, talus and calcaneum from her fall. She was immobilised in an Airboot cast but unfortunately remained in significant pain. A course of cortisone injections were unsuccessful in relieving her symptoms and our client subsequently underwent debridement surgery with cheilectomy to fix the fractures in her foot. Following surgery, our client suffered from nerve pain (a known and non-negligent complication of debridement surgery) and continued to experience discomfort on activities. At the point of settlement, our client was still unable to resume running or any other impact sports and activities. She was unable to complete her annual fitness test required to return to her job as a frontline police officer and instead had to be transferred into a sedentary role within the police.

We obtained preliminary evidence from consultants in emergency medicine and orthopaedic surgery. Expert evidence determined that the fractures had been visible on the initial x-rays performed in A&E, at which point they should have been diagnosed and immobilised. Orthopaedic evidence obtained for our client confirmed that had the fracture been treated appropriately in the first instance, on the balance of probabilities, she would have gone on to make an uncomplicated recovery and she would have avoided debridement surgery. Had the surgery not been required, she would not have developed nerve damage and would not be restricted in her ability to undertake her usual day-to-day activities.

An early Letter of Claim was served on the trust, following which it was admitted that there had been a failure to report the fracture and to give safety netting advice to return if her symptoms did not improve within 7-10 days. The trust admitted that our client should have been advised to non-weight bear and that, had this advice been given, she would not have experienced the extended period of pain and suffering pending her eventual diagnosis. Causation in respect of our client’s long-term outcome was disputed with the trust alleging that she would have required surgery in any event and was likely to have suffered residual pain and discomfort.

The parties were able to negotiate settlement without the need to issue court proceedings. The case settled for £172,500 plus our client’s legal costs to reflect her injuries and the loss of career and promotion prospects.

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