Elizabeth's Story: Missed hairline fracture still causing pain three years after injury

Our client, a woman now living with chronic pain, was sent home from a Salford hospital despite an x-ray showing she had fractured her wrist following an epileptic seizure.

Timeline of events

Elizabeth – who was diagnosed with epilepsy in 2010 at the age of 40 – was taken to Salford Royal Hospital after falling down a flight of stairs during a seizure at her home in Bury on Saturday, 12 September 2020.

Despite having a major trauma assessment and x-ray, the 54-year-old was discharged from the hospital after being told the tests had come back normal. However, when she returned to A&E due to chronic pain two weeks later, Elizabeth was informed she had a hairline fracture in her right wrist, which had gone undetected during the previous visit. In spite of this new information, the trust failed to arrange a repeat x-ray.

As it was a weekend, Elizabeth was given a temporary wrist splint and booked into the fracture clinic on Monday – meaning she was not fitted with an adequate cast until 16 days after her fall. During a review four months after her injury in January 2021, there were no signs of significant healing and a  CT scan was requested. Two months later – and more than five months of wearing a cast – Elizabeth was told the fracture had not fully healed, so opted for surgical bone graft from her wrist.

However, due to the knock-on delays of Covid-19 pandemic, the surgery never took place and instead, following some improvement in the fracture, Elizabeth was referred to rehabilitative therapy almost two years after her injury. More than three years post-injury, she was finally offered steroid injections to combat her resulting chronic pain.

How we helped Elizabeth’s case

With support from our team, Elizabeth has now settled her medical negligence claim against Salford Royal NHS Foundation Trust, which runs the hospital.

Elizabeth said: “I trusted the medical professionals when they assured me everything was fine, but the reality was far from it. I was left with an undiagnosed fracture that caused me excruciating pain and upended my life.

“The misdiagnosis left me physically debilitated and took a toll on my mental wellbeing – I’ve had to cancel weddings, and struggling with everyday tasks such as washing my hair and putting the shopping away was a constant reminder of my deformity.

“I’ve broken bones and suffered fractures before, all of which healed in around eight weeks. But this one has been a traumatic and lengthy journey, which is still ongoing. If I hadn’t returned to A&E, the consequences could have been far worse.”

After a legal battle against the trust, we secured an out-of-court settlement and apology for the substandard care Elizabeth received.

A note from Catherine Leong

“There were several failures in the treatment Elizabeth received at Royal Salford Hospital, including a delay in diagnosing the fracture and a lack of appropriate follow-up care.

“In the light of much more life-threatening potential injures to the head, neck, chest, abdomen and pelvis, the initial focus of the examining doctor’s attention was correctly to rule these out. Sadly, the failure was to not turn their focus on the secondary issues, which were undoubtedly the recognised and documented tenderness that was found in Elizabeth’s right wrist, which had prompted the request of the wrist x-ray.

“Had the radiographs been interpreted correctly, an above-elbow temporary cast would have been given to Elizabeth the same day as the fall and an appointment to attend the fracture clinic within a week – rather than two weeks later, when it is likely the fracture had been displaced.

“The continuous delays experienced by Elizabeth were extreme and unnecessary and, had they been done within a reasonable timescale, the fracture would have healed, avoiding a long and protracted recovery, which left Elizabeth with significant ongoing pain and suffering, and increased anxiety levels.

“We worked collaboratively with NHS Resolution to avoid litigation and secured a settlement for Elizabeth without going to court. While nothing can change the outcome following the care she received, it is hoped lessons are learned and changes implemented to ensure processes within A&E departments are improved to avoid repeat incidences.”

“Had the initial radiographs been adequately scrutinised, as should have been the case, then this fracture would have been identified. However, as is often the case in very busy emergency departments, it is some of the most junior doctors caring for patients who may miss subtle fractures like this.

“As a ‘safety net’, the Royal College of Emergency Medicine recommends x-rays should be reviewed by an advanced radiographer or a radiologist in the x-ray department within 48 hours of discharge, even if they were felt to be normal. This ‘safety net’ was lost in this case because the x-ray was not seen for reporting until 13 days after Elizabeth was discharged. As such, there was a breach of duty of best practice according to The Royal College of Emergency Medicine.”