Claim settled against Basildon Hospital for failings in management of wrist fracture

Posted: 08/02/2016

The Penningtons Manches clinical negligence team has recently agreed the settlement of a claim against Basildon Hospital for a number of alleged failings in the management of our client’s wrist fracture, which resulted in a significant delay in surgery and, in turn, caused her many avoidable long-term problems.

In September 2011, our client sustained a displaced fracture of the distal radius of her right arm, with a visible “dinner fork” deformity. Her injury was initially treated in A&E by way of manipulation under anaesthetic. Two attempts were made before the fracture was deemed to be in a suitable position and she was then discharged from A&E with a “backslab Plaster of Paris” with the advice to return to the fracture clinic for follow-up in a week’s time. 

Our client duly attended the follow-up appointment just over a week later and, although the X-rays showed some movement in the fracture, she was told that the fracture was still in a suitable position and, although it did not require surgical intervention, the fracture needed to be kept under review. 

At a second appointment at the fracture clinic two weeks later, a further X-ray was taken and the result reviewed by a staff grade orthopaedic surgeon. He explained to her that there had been ‘some movement of the bones’ but he did not go on to explain what this meant. Our client’ s treatment options were that she could ‘either continue to have her wrist in plaster’ or she ‘could have a pin put in it’. Our client was unaware of the pros and cons of each of the treatment options and asked the surgeon what he would recommend, to which he responded ‘50% of surgeons would opt to fix it with surgery and 50% would not’. As our client understood that the surgery did not carry any significant benefit over continued conservative treatment, she opted for continuation of plaster cast treatment as the least invasive option. 

At a follow-up appointment four weeks later, the X-ray showed that the position of the fracture had deteriorated significantly, and was noted to have “collapsed and displaced”. Upon removal of her plaster cast, our client was shocked at the severity of the deformity of her wrist and the gross swelling to her fingers. She was referred to a specialist hand surgeon to discuss the future course of treatment and was subsequently listed to undergo a procedure called an “Open Reduction and Internal Fixation” (ORIF) under general anaesthetic with insertion of plates and screws and an Allograft (bone from a human donor). 

The surgery was performed three months after sustaining the injury but our client has been left with significant problems in her wrist, which are likely to be permanent, including a visible deformity of the thumb, stiffness to the hand and wrist, exacerbations of pain, Chronic Regional Pain Syndrome (CRPS) and she was found to have a “neuroma” on her radial sided nerve. Her symptoms continue to restrict her day-to-day activities, including in the workplace, and she was deemed to be at a disadvantage on the open labour market if she was to look for another job in the future. 

Expert evidence from a consultant orthopaedic surgeon was subsequently obtained, whereby a number of failings were identified in the care our client received during her second fracture clinic attendance. Our expert was of the opinion that the X-rays taken at this time demonstrated that the fracture was moving and that there was a significant risk of further movement with continued conservative treatment. Our  client should have been informed of this risk. 

Furthermore, our expert was of the view that our client was not appropriately and fully informed of her treatment options from this point on together with the associated risks and benefits of each treatment option. If she had been appropriately informed of the risks of further movement of continued plaster cast treatment, she would have opted for surgery at this time, which would have more likely than not been performed by way of k-wire stabilisation, which is a less invasive form of surgery than that of ORIF. If this form of surgery had been carried out, our client would have avoided the need for and ORIF procedure and she would have avoided her ongoing problems. 

Following a letter of claim to the trust, only partial admissions on liability were received and the trust denied that any damage had been caused by its failings. Consequently, court proceedings were subsequently issued and served. Although the trust maintained its position on liability, negotiations were recently entered into resulting in a good settlement for our client. 

Naomi Holland, a member of the Penningtons Manches clinical negligence team who ran this case, said: “This case highlights the importance of doctors taking the time to ensure that any patient is aware of any material risks involved in any recommended treatment, and that advice on any alternate options for treatment and the relative ‘pros and cons’ is given. Our client was neither informed of the risks in continuing with conservative treatment during her second fracture clinic attendance nor of all her treatment options. She has been left with long term problems because of the failure to recognise the severity of her situation and to properly advise her. It is frustrating that the trust maintained an argument that no damage had been caused for so long, only then to settle the case once substantial additional costs had been incurred.”

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