A&E misses scaphoid fracture of wrist

We settled a claim against Darent Valley Hospital for negligently failing to diagnose and treat a fractured scaphoid. Our client was aged 21 when he was playing football and fell forward during a tackle, landing on his outstretched arm and bending his wrist backwards.

He went to the Urgent Care Centre at Darent Valley Hospital, where he was examined. The examination recorded swelling and pain on movement of the wrist, but that there was no tenderness in the area associated with the scaphoid, a small bone on the inside of the wrist. Fractures of the scaphoid are commonly associated with falls of the type our client described. The assessment that was made of our client, however, failed to detect the classic tenderness and he was diagnosed with a sprain and sent home. As a result, the possibility of a fractured scaphoid was overlooked. While a scaphoid fracture cannot necessarily be confirmed by examination or X-ray on the date of injury, where such a fracture is suspected a patient's wrist should be immobilised and re-assessed within the next 10-14 days at which point any fracture should be identifiable on radiology.

Our client relied upon the hospital's advice and continued with life as normal. He remained with considerable pain in his wrist and difficulty using it in a number of situations, but assumed this was simply the healing process of the damaged tissues. When things had not improved after four months or so, he went to his GP. The GP referred him and eventually an MRI was arranged that led to our client's diagnosis, nearly nine months after the injury. By then the only prospect was surgery to fix the un-united fracture using a bone graft from our client's pelvis and a screw.

We investigated the case and reviewed the notes and records before seeking independent medical expert evidence on the standard of care our client received in A&E. Our expert confirmed that the hospital had failed in its duty to our client and not properly considered and managed the possibility of a scaphoid fracture and that the fracture should have been diagnosed at a much earlier stage. Our expert orthopaedic surgeon confirmed that had the hospital treated our client as it should have done, he would have been managed without the need for surgery and the fracture would have gone on to heal uneventfully.

We wrote to Darent Valley Hospital to set out the chronology of our client's management and the failings we alleged in the care it provided. The NHS Litigation Authority investigated the case and admitted negligence in the hospital's care. We offered to settle the claim for our client for £25,000 plus his legal costs, which the NHS LA accepted.

The case was conducted by associate Andrew Clayton and supervised by partner Philippa Luscombe.

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