Missed Arm Fracture Case Study

Orthopaedic injury: LR v Basildon and Thurrock University Hospitals NHS Foundation Trust

Our client LR was 69 years old, had a fall at home and was taken to the A&E Department at Basildon University Hospital. She pursued a claim in relation to clinical negligence arising from delays in diagnosing her fractured right femur on her presentation to hospital.

An Emergency Nurse Practitioner assessed and examined her, and an X-ray was ordered.

The note of the attendance includes “x-ray right femur query fractured right leg”. However, neither the reporting radiographer nor the Emergency Nurse Practitioner realised that LR had suffered an undisplaced sub-capital fracture of her right hip. Post-X-ray she was told that she had no broken bone but rather bruising and ligament damage. A working diagnosis was “contusion/soft tissue injury right thigh”. She was told to go home and mobilise and was given crutches and analgesia. Following this attendance, the X-ray report was not sent to LR’s general practitioner.

LR contacted her GP when she was still in great pain, and her analgesia had run out. Her GP did not have any information from Basildon University Hospital but prescribed co-codamol.

Later in the same month, LR returned to Accident & Emergency at Basildon University Hospital by ambulance, reporting that she had been unable to bear weight since the event and had swelling on her right leg. She was again seen by an Emergency Nurse Practitioner and told that she did not need further X-rays. The nursing staff were concerned that LR had a blood clot in her right leg. She was given warfarin to thin her blood and told that she needed an ultrasound scan to check that she had no clot in her right leg. She was again discharged home in agony and told to mobilise, despite being in extreme pain. She was referred to the DVT clinic.

An ultrasound scan investigated the potential of DVT but was reported by the sonographer as being negative, and therefore LR’s anticoagulation was discontinued.

LR suffered swelling in her lower right leg and once again visited her doctor. No examination of her hip took place, and no note was made of the continued pain and the lack of change in LR’s condition since her last attendance. An x-ray of her lower right leg was requested. During another visit to her doctor, LR reported a dull ache and cramp in her right hip, had oedema and was still on crutches 5 weeks after her initial fall. Her GP, at this point, requested an urgent MRI scan of LR’s right hip and legs, but the radiology department at Basildon University Hospital refused this.

Another week or so passed, and LR was still no better, so she made another visit to see her GP. She was still in pain, not sleeping and unable to mobilise without crutches. Her GP still did not have the x-ray reports from A&E. However, he noticed she had an antalgic gait and very poor straight leg raising on the right side. He felt that an urgent hip X-ray was required.

LR was once again referred to Basildon University Hospital for an x-ray and, on this occasion, was informed she had suffered a fractured right hip and a shattered femur, which had happened as a result of her being told to mobilise. Our client underwent a total hip replacement under the care of a Consultant Orthopaedic Surgeon. She was eventually discharged home from hospital on crutches; attended several follow-up appointments and underwent physiotherapy.

LR required care and domestic assistance from her daughters and her husband. She could not use the stairs at home and so had to sleep downstairs in an armchair. She had to use a commode to go to the toilet, which was embarrassing for her. She had to strip wash and her husband would assist her with this as she could not stand. She was also unable to drive and cycle. This affected LR’s psychological wellbeing and her anxiety increased as a result of the failure to diagnose the fracture in a timely manner. She was also prescribed and took rivaroxaban 15mg twice daily for two weeks, to treat DVT, which she did not have.

Our client has been left with a slight limp as a result of the delay in treatment and the need to undergo more extensive surgery instead of the fixation of her fracture with 3 cannulated screws. She initially had an un-displaced fracture which developed into a displaced fracture as a result of LR being told to mobilise. LR is recommended to undergo a revision right hip replacement in 15 years.

A settlement was reached out of court for five-figure damages.