Case study: missed foot fracture leads to permanent damage
Joanne, 47, developed pain in her left foot over a period of two weeks and her GP sent her for an X-ray, which was reported as being normal with no fracture seen. However, the pain and swelling in the foot continued and Joanne was referred to an orthopaedic surgeon.
Sent home from A&E
As the pain was getting worse and she was about to go on holiday she felt she could not wait for the orthopaedic referral and presented herself at A&E where she was examined and reassured that there was no fracture, although no further X-ray was taken.
Fracture found but not treated
Joanne then had a number of sessions with a physiotherapist but these made little difference to the pain and she returned to her GP four months after the initial consultation. She was then referred to a podiatrist who requested a further X-ray. This time a fracture was seen in one of the bones of her third toe but the podiatrist advised that it was too late to do anything about it and that it would heal on its own.
Two years later, after a very busy day at work, Joanne noticed a new pain in her left foot and an X-ray showed an old healing fracture of the 3rd toe and a new stress fracture of the 2nd toe. She was seen at the fracture clinic and the foot was put in a slipper cast for two weeks. When the cast was removed the pain and swelling had reduced and the consultant (Mr W) discharged her claiming that no fracture was evident on the X-ray.
Signed off work and an operation to stabilise the fractures
However, the pain continued and Joanne was signed off sick from work. Eventually she was seen by a second orthopaedic surgeon who sent her for a CT scan. This showed that neither of the fractures had fully healed and she would require an operation to fuse them and stabilize them with screws. The operation was reasonably successful in that both fractures were stabilised but there was some doubt about whether they would ever fully unite. She is much better than she was but continues to take regular pain killers for the pain in her foot.
Claim for negligence
It was claimed that the A&E department was negligent in not taking another X-ray when she attended with a six week history of foot pain. It is well known that stress fractures are often not visible in the first two weeks of symptoms. If she had had an X-ray at this stage it is likely that the fracture would have been seen, she would have been put in a non-weight bearing cast for six weeks and the fracture would have fully healed.
It was also claimed that the orthopaedic consultant, Mr W, was negligent two years later when he discharged Joanne claiming that both fractures had healed. With an appropriate standard of care she would have been referred to a foot and ankle specialist for further management.
After seeking advice from Hospital Negligence Joanne eventually received £20,000 in compensation.
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