Penningtons Manches’ clinical negligence team has agreed the settlement of a claim against Royal Berkshire Hospital (part of Royal Berkshire NHS Trust) for an alleged failure to investigate and diagnose a finger fracture appropriately. The substandard care caused the firm’s client to suffer prolonged and unnecessary pain during the period in which the fracture was undiagnosed and led to the need for more invasive surgery.
The client initially attended a minor injuries unit late one evening in May 2014, having sustained an injury to the little finger of her dominant hand while horse riding. When she removed her glove, she noticed a very apparent deformity with the finger, which she described as “sticking out to the side”. On examination at the minor injuries unit, the nurse noted that there was a reduced range of movement in the finger, tenderness and an “obvious deformity”. She queried whether the woman had sustained a dislocation, or a fracture to her finger. Given the severity of the injury and the restricted resources at the unit, Penningtons Manches’ client was told that she needed to attend A&E, so that this could be investigated further.
On arrival at the A&E department at Royal Berkshire Hospital later that night, the client was seen by an A&E nurse, and it was again documented that her finger “deformity” was apparent on visual inspection. An X-ray was performed and she was assured that her injury was minor. The recommended treatment was that of “analgesia, rest, elevation and neighbour strapping”. No advice was sought from an orthopaedic doctor on call, and the only follow-up instruction was for “GP follow up, return if necessary”. No explanation was provided as to why the finger looked so deformed.
The woman presented to her GP surgery a couple of days later, when she expressed concern about the advice provided by the A&E practitioner on the management of her finger fracture. The GP expressed his own concern that the X-ray was not reviewed by an orthopaedic surgeon at the hospital and contacted the A&E department on her behalf. Following a conversation between the GP and the A&E department, the woman was subsequently booked to attend the fracture clinic.
During this appointment, no further X-rays were taken and only a cursory examination was performed. Following a brief discussion, the woman was assured that buddy strapping was appropriate treatment for the injury she had sustained and she was then discharged from the fracture clinic’s care.
Due to the severity of the deformity, she remained apprehensive about the advice she had received and decided to obtain a second opinion on a private basis. An appointment was arranged 10 days after her attendance at A&E. Further X-rays were performed at the private clinic and she was told that she had sustained a “very obvious nasty fracture” to the proximal interphalangeal joint of her little finger. The fracture had “split at the joint” and had displaced. A review of the X-rays taken during her initial A&E attendance was undertaken by the private doctor, and she was informed that they had been performed at an “incorrect angle”. The woman was also told that the finger fracture had already started to heal and that the only option for treatment by this time was through open surgery. There was a high possibility of soft tissue damage and a risk that she would never be able to regain full motion of the finger again. The specialist believed that if the fracture had been correctly treated earlier on, she could have had less extensive surgery.
The woman was then listed to undergo open reduction and internal fixation under general anaesthetic. While the surgery proceeded without complication, she experienced a very difficult period of recovery and continued to suffer problems with pain, stiffness and some deformity of her finger, restricted range of movement and restricted grip capability. This was particularly problematic as the injury was on her dominant hand. Unfortunately, her recovery was further complicated due to the need to undergo more surgery some 14 months later.
She was understandably concerned about the treatment and care provided during her initial A&E attendance and her fracture clinic review, and therefore instructed Penningtons Manches to represent her. Following preliminary investigations, a pre-action protocol letter of claim was sent to the defendant trust, with an early offer of settlement. A full admission of liability was received and the offer of settlement was accepted without the need for long and protracted litigation.
Naomi Holland, a solicitor in Penningtons Manches’ clinical negligence team who ran the case to conclusion, commented: “Unfortunately we deal with many cases involving misdiagnosis or delayed diagnosis of fractures which can result in deterioration, potentially more invasive surgery, and sometimes a worsened outcome. In our experience, misdiagnosis can occur after a failure to obtain an appropriate history of the mechanism of the injury and site of the pain, to carry out a proper examination or to perform / interpret X-rays appropriately. Most patients are keen to avoid surgery if possible, and with some fracture injuries, prompt diagnosis and treatment can result in a good outcome without the need for surgery. However, if a fracture is left without appropriate diagnosis and treatment, it can worsen, and the treatment options from that point on can be very limited. Our client wishes to highlight the issues arising in her care in the hope that future incidents can be avoided.”
If you or a family member have concerns about the management of a fracture injury, our specialist orthopaedic injuries team may be able to assist.