Fractures and medical negligence

Some fractures are obvious such as open fractures where one end of the broken bone punctures the skin. However closed fractures are the most common type and these will not always be evident and can be missed.

With some fractures no specific treatment other than support, rest and pain relief is appropriate and therefore if those fractures are missed the consequences will not be significant. Examples of these are fractures to single ribs and some fractures to the collar bone. However, many fractures will require treatment either through immobilisation in a plaster cast or surgery.

Fractures can be missed because the doctor might decide that an injury involves soft tissues only. Such a decision might well be medically negligent if the doctor has failed to take an appropriate history or failed either by examination or x-ray properly to investigate a suspicion of fracture.

Sometimes a patient will attend a day or more after having sustained the injury and the bruising and swelling to the affected site might be such that the only means of obtaining a reliable diagnosis is by x-ray.

If the doctor fails to order an x-ray that might well constitute medical negligence.

Even when an x-ray has been ordered, sometimes the x-ray will be misinterpreted. Fractures that are typically missed on x-rays include fractures to the hand, wrist, pelvis, hip and the top of the leg.

Fractures in the elderly are often missed more than in those who are younger.

Also the doctor has to ensure that when x-rays are ordered the precise suspected location of the fracture is identified properly as otherwise the x-ray will be of the wrong area and worthless.

Finally, the x-ray itself might be of an insufficient quality to assist diagnosis in which case it should be, but is not always, repeated.

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