Clinical negligence team sues Sussex hospitals for missed diagnosis of Lisfranc fracture

Posted: 29/07/2014

Penningtons Manches' clinical negligence team has made a claim against two Sussex hospitals on behalf of a diabetic client who developed significant swelling in his foot following a jump of between three and four feet down from his lorry cab. Although he had no pain, he went to his local Minor Injuries Unit in Sussex the following day and told them that his jump down from his lorry was the only explanation he could conceive as to why his foot had become swollen. 

The hospital notes refer to visible swelling of the left lower leg and ankle, although with no skin discolouration, normal temperature and no pain on palpation or movement.  The patient was weight bearing and the impression was that he might have developed a DVT.   No X-ray was arranged but he was referred to another local hospital for exclusion of a DVT (which took place).  The history of his jump and potential trauma was not documented. 

The swelling worsened and a couple of weeks later he attended A&E at another local hospital.  The notes of that attendance again refer specifically to 'no preceding trauma/injury'  despite his repeated mention of his jump from his lorry. He was told that this was most likely a sprain and that no X-ray was required.  He returned home to continue resting his leg and thereafter went back to work.   

Approximately 10 days after his A&E attendance, the patient developed severe pain in his leg and also noticed a lump on the base of his foot. He returned to the Minor Injuries Unit the following day and explained his history.  Again no X-ray was done and a DVT was investigated and excluded.

Eventually, due to his ongoing problems, he was referred to a vascular team who immediately ordered an X-ray which revealed a Lisfranc dislocation with avascular necrosis for which he was referred for orthopaedic treatment.  Unfortunately, he developed further problems with foot ulcers due to his diabetes and required prolonged treatment with only a partial recovery.

Penningtons Manches' clinical negligence team obtained expert evidence which was critical of the failure to investigate a bony injury at the later appointments when the patient's problems were ongoing and to diagnose the fracture at an earlier stage. The expert evidence concluded that if a definitive diagnosis of Lisfranc fracture been made within four to six weeks of the date of injury, treatment by immobilisation in plaster would probably have improved the outcome. The deformity and ulceration to his left foot would also have been avoided.     

The team submitted details of the claim to the hospitals concerned but their response was to argue that they were unaware of potential trauma, that the management and investigations were reasonable and the failure to make an earlier diagnosis was not negligent.  They accept, however, that earlier diagnosis would have resulted in a better outcome.

Philippa Luscombe, partner in the clinical negligence team at Penningtons Manches LLP, said: “Given the fact that the case is disputed, the degree of our client’s long term problems, and our supportive expert opinion, we have issued proceedings against the hospitals concerned to progress our client’s claim.

“We are currently dealing with a number of cases of foot and ankle injuries where X-rays have either not been performed or not properly interpreted.  In this case, our experts felt that it was reasonable not to immediately X-ray our client’s foot but are critical of the failure to investigate further when his problems continued and deteriorated.  Sadly, he has suffered a poor outcome which would have been avoided if earlier action had been taken. Given that the hospitals concerned are not acknowledging any failures, we are issuing proceedings to work towards a determination of the case at trial if it cannot be resolved before.”   

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