Settlement achieved for delayed diagnosis of scaphoid fracture following mountain bike injury

Posted: 02/07/2019

Penningtons Manches Cooper’s clinical negligence team has settled a claim against Royal United Hospitals Bath NHS Foundation Trust for a failure to diagnose a scaphoid fracture appropriately which resulted in delayed treatment.

On the afternoon of 17 June 2016, the firm’s client was mountain biking at a local bike park. During one of his descents, he fell off his mountain bike and landed palm down on his outstretched left hand / wrist. He had been travelling at approximately 10 - 15 mph at the time of the incident.

He immediately experienced severe pain in his left hand / wrist, particularly around the thumb area. Limited first aid was provided at the scene and the client was advised that, if the pain did not improve, he should attend hospital.

The client visited his local A&E department, at Royal United Hospital, later that day. He was seen and assessed by a nurse practitioner and he informed her of the history of his fall, and specifically, that he landed ‘palm down’. A limited examination was performed and the nurse documented an impression of a left wrist fracture and arranged an X-ray of the client’s left wrist. The X-ray ruled out any bony injuries and he was discharged with advice to exercise his wrist actively.

Over the course of the following weeks he exercised his wrist as instructed by the nurse, which caused him pain and discomfort. The range of movement in his left wrist continued to be limited. As his symptoms were not improving, he arranged an appointment with a private sports physiotherapist. During this appointment, the possibility of a scaphoid fracture was raised and he was referred to a specialist hand surgeon for investigation and management.

A scan was performed and a diagnosis of a scaphoid fracture was confirmed. Unfortunately, due to the delay in diagnosis, conservative management by way of a plaster cast was no longer an option and the client underwent invasive surgery in the form of open reduction and internal fixation with plates and screws. A second operation was subsequently required to remove the plates and screws. The client has been left with permenant scarring and some restriction in movement and grip strength, which could have been avoided with an earlier diagnosis.

The client instructed Penningtons Manches Cooper to begin a claim against the trust for failing to suspect and investigate the possibility of a scaphoid fracture appropriately. Expert evidence was subsequently obtained which identified a number of failings in his care and crucially in failing to suspect a scaphoid fracture given that the mechanism of falling ‘palm down’ is typical for such an injury. The expert was of the view that there was no evidence that an examination of the scaphoid fracture was performed and the X-rays did not incorporate the scaphoid. Had the scaphoid X-rays been incorporated, this would have demonstrated the fracture.

A letter of claim was subsequently submitted to the trust which set out the allegations of negligence in the client's care. Despite liability in the matter being thoroughly contested, Penningtons Manches Cooper secured a settlement for the client without the need to issue court proceedings.

Naomi Holland, an associate in the clinical negligence team who ran this case, said: “It is crucial that any medical practitioner takes notice of the history of the mechanism of the injury and performs an appropriate examination to ensure the correct diagnosis is reached. Unfortunately, the delay caused by the trust had a significant impact on our client’s treatment options and his recovery. We hope that by raising awareness of these issues, this will avoid similar incidents in the future.”

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