Compensation awarded for missed diagnosis of scaphoid fracture to the wrist

We recently achieved a settlement against Barts Health NHS Trust for a failure to diagnose our client’s scaphoid fracture despite several opportunities. Our client is an architect, and has been left with reduced grip strength and a limited range of movement in her dominant wrist.

Our client had a skiing accident, and fell on her outstretched right hand. She was diagnosed with a fracture dislocation of her right elbow and her arm was put in a cast. She was advised to attend hospital immediately on her return to the UK as she would likely require operative fixation.

On returning to the UK, our client attended the A&E department at the Royal London Hospital. The cast was not removed but her wrist pain was documented and x-rays of the wrist and elbow were performed through the cast. No obvious fracture to the wrist was observed on the x-ray and it was noted that a CT scan would need to be performed. The scaphoid fracture was apparent on the subsequent CT scan, though it was not correctly reported as such and our client was falsely reassured.

Four days later, our client returned to have surgery to fix her elbow fracture. She continued to suffer from swelling and pain in her right wrist, and saw her GP who advised her to return to hospital. Her wrist was examined and it was noted that the ‘snuff box’ area (at the base of the thumb) was tender – a characteristic sign of possible scaphoid fracture. She was reassured that it was likely to be a soft tissue injury which would heal with time. Our client attended the fracture clinic at the hospital on several occasions over the next few months, continuing to complain of ongoing pain in her right wrist, but no action was taken.

Our client returned to work and found that the pain in her right wrist worsened with use. She continued to attend the fracture clinic at the hospital for follow-ups. Each time, she was reassured that she had suffered a soft tissue injury to her right wrist and no further investigations were carried out.

Finally, some seven months after her first attendance at the hospital, she was referred for a scaphoid x-ray to specifically view the scaphoid bone. The fracture was spotted and confirmed on CT and MRI scans. Her wrist was put in a cast and she had surgery to unite the fracture.

We obtained expert evidence from an A&E consultant and a consultant hand surgeon before sending a letter of claim to the defendant trust, setting out our allegations against it. The defendant responded by admitting that it was negligent in failing to correctly report the first CT scan as showing a scaphoid fracture and failing to take note of our client’s continuous symptoms of pain, swelling and tenderness in the wrist. The trust initially denied that our client had suffered from any permanent injury as a result of its negligence. However, following disclosure of a report prepared by a consultant hand and wrist surgeon who we instructed to assess our client, the defendant accepted that her grip strength and range of movement fell outside of the normal range that would be expected if appropriate surgery had taken place at an earlier time. Our client continued to suffer from ongoing pain in her wrist, but it is accepted that this was as a result of the injury itself rather than the negligence.

Rosie Nelson, an associate in the clinical negligence team who acted on this case, commented: “We see many claims like this where a scaphoid fracture has been missed, and as with other types of missed fracture, timing of intervention is key to avoid permanent disability. We are pleased to have settled this claim for our client to reflect her permanent injuries to her dominant wrist, which in her role as an architect cause her considerable issues.”

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