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Your guide to undiagnosed bone fracture

X-ray image of a fractured arm

Failure to diagnose and treat a bone fracture because an X ray was not taken or interpreted incorrectly is the most common error made in a A&E department at a NHS hospital.

If a broken bone is not treated quickly, the outcome can be very serious. The bone may fail to fuse together or heals in the wrong position and complex surgery is later needed.

At the very least, prolonged pain and restricted movement is suffered by the patient, which can also lead to long term problems of pain, limited function, even disability.

An A&E department has a responsibility and ‘duty of care’ to correctly diagnose a patient’s bone fracture and refer them on to an orthopaedic specialist. They should be able to:

  • Recognise that a fracture may have been caused by  the type of  accident, and
  • Commission  an x-ray .

If you feel that you or a family member have not received the  appropriate standard of care, which has led caused  harm and suffering  you may have a  clinical negligence claim.

Starting a claim for clinical negligence is not always an easy decision. The  process can be complex.  If you have good reason to believe that “something was not quite right” with any aspect of the  diagnosis, treatment or surgery, you should always seek professional advice.

Your Legal Friend is  experienced in successfully resolving many different types of clinical negligence cases.  Our specialist knowledge of both legal and medical issues together with a sympathetic and sensitive understanding of how everyone involved is affected means we can help you:

  • Find out the reason why something went wrong with a diagnosis, treatment or procedure.
  • Obtain  compensation for the injury or harm caused, which may lead to a long term disability.

Missed or delayed X-rays...

  • Around 50 per cent of the 20 million plus visits to A&E involve having an X-ray, mostly to check for bone injury.
  • One in four NHS radiology departments took more than 30 days to assess 80,000 X-rays by a radiologist.               (NHS survey, 2014)
  • An estimated 300,000 patients are waiting more than a month for their X-rays to be analysed.               (Royal College of Radiologists, 2014)
  • Patients whose X-rays were checked by a specialist before they left A&E were three times less likely to have a missed fracture.               (University of Bradford School of Health Studies, 2013)                                                                   
  • Junior doctors in A&E miss up to 39 per cent of ‘clinically significant abnormalities’ on X-rays.               (Study, British Medical Journal)

What are the main symptoms of a fracture?

The main symptom of a fracture is severe pain, which may make you feel light-headed or nauseous and can intensify when an attempt is made to move the affected limb or area.

Other symptoms, which could suggest a fracture include:

  • Swelling
  • Bruising 
  • Bleeding
  • Dislocation, deformity or twisted appearance.
  • Numbness
  • Paralysis
  • Weak pulse below the fracture

What happened when you went to A&E?

If you thought you fractured a bone, and went along to an A&E department, did the doctor:

  • Ask you about your symptoms?
  • Examine you for signs of a fracture, such as swelling or tenderness?
  • Ask you about your medical history, such as accidents or falls?
  • Take an X-ray of the affected area?
  • Order an MRI or CT scan?
  • Diagnose you with a sprain injury, given pain killers and sent home?

Reasons why your fracture could have been missed or misdiagnosed

  • Symptoms not commonly seen with a fracture - your description of the accident and symptoms presented do not automatically suggest to the examining doctor that a fracture has occurred.
  • No X-ray taken.
  • X-ray incorrectly taken - your X-ray may not have been taken at the right angle to detect the fracture  leading the doctor to believe a fracture has not occurred despite the symptoms.
  • Fracture hard to see on the X-ray -  up to nearly a third of fractures in the bones of the hip and pelvis can  fail to be spotted by an X-ray.
  • X-ray results not passed on to the doctor.
  • No further investigation by a CT or MRI scan.
  • An inexperienced doctor - A&E patients are most likely to be seen by junior doctors working at evenings and weekends at one in five A&E departments.

What happens if a fracture is missed?

Failure to diagnose a fracture can lead to:

  • Severe, unnecessary pain
  • Incorrect healing to the affected area
  • Long-term damage to the affected  part of the body

Certain types of fractures more likely to be missed are...

  • Hairline fractures - where the bone is broken but not misaligned. Appears as a fine line on an X-ray, which can be overlooked.
  • A hidden bone - commonly occurs  with fractures to the small bone in the wrist near the base of the thumb, known as the scaphoid bone.

Missed scaphoid fractures

Fractures to the scaphoid often occur as a result of a fall on to an outstretched hand, where the impact of the fall forces the hand and wrist back.

Difficulties in detecting scaphoid fractures have been widely reported as they are hard to diagnose because the bone is inside the joint. Misdiagnosis sometimes happens because of a lack of swelling and no visible injury.

A missed scaphoid fracture can lead to serious problems including:

  • Reduced grip and range of motion.
  • Failed or delayed fusing together.
  • Osteoarthritis.
  • Disruption to the blood flow causing the bone to die

MRI scanning for missed scaphoid fractures

Patients with a suspected scaphoid fracture and tenderness in the wrist area are recommended by medical guidelines to be given a MRI scan even if the X-ray comes back clear.

In more serious cases...

A serious fracture left undiagnosed can result in permanent disability because the bones re-grow in the wrong way, resulting in impaired movement or disability.

Other complications of a fracture, if left untreated, can include:

  • Compartment syndrome – a dangerous condition which can result in amputation if not dealt with as soon as possible
  • Fat Embolism – can also result in death if not diagnosed and treated promptly
  • Deep Vein Thrombosis (DVT)
  • Long term tenderness and joint stiffness
  • Osteomyelitis – inflammation of bone and bone marrow, caused by infection.

 Undiagnosed fracture - do I have a claim for clinical negligence?

You may have good grounds to make a claim for an undiagnosed fracture, if you are able to show:

  • A missed or negligent diagnosis  - below a standard of appropriate care that should have been  provided.
  • Incorrect treatment after diagnosis - including ineffective treatments to initially treat a fracture when more active methods are required.
  • Errors in joint reconstruction –  due to the many different types of fractures, which can affect the type of treatment best suited to the fracture suffered and appropriate in each individual case. The severity and location of a fracture can also affect the way in which the fracture is fixed.

There are TWO main types of compensation  that you can claim for an undiagnosed fracture:

  • General damages - for the pain and suffering incurred.
  • Special damages - to compensate for any financial losses, e.g. if you have had to miss work or your quality of life has been seriously affected by the missed diagnosis.

How Your Legal Friend can help you..

As experienced clinical negligence specialists, we know that many of those who have been affected by an undiagnosed bone fracture will want to seek an explanation for why you were badly let down by the hospital and received sub-standard treatment.

Your Legal Friend is committed to ensuring victims of clinical negligence are able to make their case, obtain answers and receive the justice and compensation to secure their present and future care needs.