Orthopaedic Injuries

The nature of orthopaedic work falls into two main categories:

• Trauma, which includes fractures and dislocations
• Other conditions such as infection, tumours, degeneration and congenital problems

Like doctors in other fields, orthopaedic surgeons tend to specialise into subgroups, such as spinal surgery, trauma or paediatric surgery.

Orthopaedic errors

Orthopaedic surgeons can be prone to error. The Orthopaedic Error Index for hospitals aimed to provide the first national assessment of errors within orthopaedic surgery and trauma provides the statistics. For the period 2009-2010, 155 hospitals reported nearly 49,000 orthopaedic related patient safety incidents with varying degrees of harm: 70.5% no harm, 23.5% low harm, 5.4% moderate harm, 0.5% severe harm and 0.1% death.

Diagnostic Errors with orthopaedic injuries

Diagnostic mistakes in orthopaedics are to a large extent due to misreading X-rays and missing fractures. The current organisation of orthopaedic cover in Accident and Emergency Departments means that junior doctors are usually first to review X-rays. This leads to a greater chance of misdiagnosis of an injury. Hand and foot fractures are a most commonly missed.

The Aston Villa midfielder Jack Grealish has spoken out about playing with a fractured shin. In December, he injured his leg during a match. The pain which radiated into his ankle and foot was ‘horrific.’ The team doctor gave him an injection to relieve the pain and he continued to play. It was not until the following morning when he went for a scan, that the fracture was diagnosed.

In another recent case, an otherwise fit and healthy woman who sustained a fractured femur while running was mis-diagnosed as having a pulled hamstring muscle. Despite severe pain and swelling and being unable to weight-bear, no X-rays were taken. When the fracture was finally discovered four days later, she underwent an operation to straighten her leg, but died on the table due to a cardiac arrest. Her traumatised family believe the delay in diagnosis contributed to her death and are currently awaiting the results of the inquest.

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 Hospitalpursued a claim in relation to clinical negligence arising delays in diagnosing her fractured right femur on her presentation to hospital.

She was assessed and examined by an Emergency Nurse Practitioner, 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 subcapital fracture of her right hip. Post X-ray she was told that she did not have a broken bone but rather bruising and ligament damage. A working diagnosis was of “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 own 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 weight bear 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 to have 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 did not have a clot in her right leg. She was again discharged home in agony and told to mobilise, despite being in extreme pain when doing so. 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 and this taken. 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 this was refused by the radiology department at Basildon University Hospital.

Another week or so passed and LR was still no better and so made yet another visits to see her GP. She was still in pain, not sleeping and not able 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 was unable to 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 very embarrassing for her. She had to strip wash and her husband would assist her with this as she was unable to 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 a day 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. It has been recommended that LR undergo a revision right hip replacement in 15 years’ time.

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

Equipment errors

A report in the Health and Safety Journal published in February 2019, highlights a National Patient Safety Alert issued by NHS Improvement. There are concerns that thousands of patients received incorrect metal plate implants during their orthopaedic operation. X-rays across more than 140 trusts are to be reviewed in order to determine which patients had surgery with a metal plate for a long bone fracture since February 2018. The review was prompted after metal plates in two patients buckled. Patients with the wrong plate may require further surgery.

There were also reports that orthopaedic surgeons in a German hospital mistakenly implanted femoral components for total knee replacements without cement, even though the implants were designed to be used with cement. Of the 47 patients affected, 30 had to undergo revision surgery.

Wrong part of the body

You may be surprised to know that the incidence of wrong site errors is the highest in orthopaedic surgery, when compared to all specialities.

In 2018, the British Medical Journal reported that a consultant orthopaedic surgeon was struck off the medical register when he operated on the wrong part of his patient’s knee and then falsified records to cover up his mistake. His patient, a 28-year-old footballer now suffers with severe disability of his knee as a consequence. The GMC panel chair said that the surgeon, ‘Demonstrated a flagrant disregard of his duty of care, both with regard to his clinical failure and with his attempt to conceal his error’.

Medication errors

Medication errors can occur both inside and outside the orthopaedic operating theatre. A paper produced by The Royal College of Surgeons outlines how anaesthetists working in orthopaedic surgery settings have made errors that resulted in successful litigation. In total for the study period, nearly £500,000 was awarded to patients due to medication errors committed by the anaesthetist, including one example where pure alcohol was injected in a nerve block procedure, instead of local anaesthetic. The authors also described how two cases of wrong-side nerve block resulted in compensation paid to the patients. In another case, when an anaesthetist shaved and prepared the wrong leg for knee arthroscopy, the patient was awarded £8,300 in compensation.

Orthopaedic negligence compensation

At Osbornes Law we are acting for several clients who have suffered medical negligence caused by inappropriate screw length in corrective bone surgery which has led to pain and suffering, damage to nerve during orthopaedic surgery, incorrect surgical procedure which has led to long term disability of the foot and mobility problems.

If you think that you may have suffered due to orthopaedic negligence, contact our specialist team of medical negligence solicitors for a free confidential discussion. In order to prove negligence, there must have been a duty of care that was breached, and an injury or harm resulted as a consequence. Our team of specialists will advise you whether or not you have a viable claim for compensation and we will support you through the process.

Our Promise to You

• We will review your potential claim by advising you on the NHS complaints procedure or other alternative procedure if your case does not relate to NHS care and treatment.
• We will not charge a fee for our time in reviewing your case.
• We can assist you with any issues that you may have regarding the complaints procedure or that you encounter in obtaining copies of your medical records.
• We will advise you of the course of action in respect of your case.