NHS Trust’s failure to identify stress fracture results in delayed treatment
24th June, 2021
Case Studies

After an NHS Trust failed to identify a simple stress fracture, our 53-year-old client was immobilised for a number of months.

Following legal representation from Patient Claim Line, our client was awarded £17,500 by St George’s Healthcare NHS Trust. The hospital admitted failings in identifying, diagnosing and treating a tibial fracture.

The incident

In July 2018, our 53-year-old client began to feel pain in the front of her left leg which became more prominent when she stood.

Gradually, the pain worsened, and she developed a limp. In August 2018, our client attended her GP where she was prescribed analgesia and told to return if there was no improvement. Two weeks later, she returned to the GP with worsening pain.

The GP referred our client to St George’s Healthcare NHS Foundation Trust for an x-ray. It was here the trust confirmed that a stress fracture needed to be excluded and on 21st August 2018, our client underwent x-ray at the trust, but no definite fracture was identified.

She was told to continue with physiotherapy, which she did and was also signed off work.

On 27th September 2018, our client requested further imaging of her leg from her physiotherapist. The Physiotherapist noted that the pain had worsened and was so severe that she was now unable to weight bear on that leg.

Our client was referred for further imaging and had an MRI scan at the same trust on 26 October 2018.

The MRI scan detected a stress fracture of proximal tibial diaphysis evolved toward complete cortical fracture with inflammatory component.

Our client was immobilised and was in plaster until 4th February 2019, when bone union was finally achieved.

At this stage, it was noted that she would require around six months of rehabilitation.

The case

Following the injuries sustained, our client brought an action against St George’s and Patient Claim Line’s Assistant Litigation Executive, Sophie McGarry took on the case.

It was alleged that the trust was negligent in failing to identify, diagnose and treat a tibial fracture from the x-ray of 21st August 2018.

As well as this, our client wanted to explore further if the trust failed to adequately investigate and manage the stress fracture from 21st August 2018.

From the evidence our client had to hand, the initial images from 21st August 2018 looked to visibly show a tibial fracture with periosteal reaction.

Because of this, Sophie investigated whether there was a failure to diagnose our client’s fracture on 21st August 2018 and why, as well as if there was a delay in diagnosis (and management) of the fracture.

Questions followed, including whether the initial x-ray would have made a difference if the fracture was appropriately diagnosed, and whether an MRI scan and Orthopaedic opinion would have been sought on within a few days.

It was later identified that, but for the failure to recognise the fracture, our client would have received treatment for her fracture by 26 August 2018 at the very latest; exactly two months sooner than she did (MRI actually being performed on 26 October 2018).

PCL’s legal work also concluded that the delay in diagnosis led to two months of failure to treatment of the tibial stress fracture.

This allowed progression of the fracture from a partial cortical fracture to a complete cortical fracture and, on the balance of probabilities, increased our client’s time in plaster by a further two months.

This then led to four months of increased, avoidable treatment and care needs, overall.

Finally, this increase in time and severity of injury led to further deconditioning as evidenced by stiffness in our client’s knee and reduced muscle bulk in the calf. Our client suffered an increase in physiotherapy needs and suffered loss of earnings from the time needed away from work.

The outcome

A final settlement was awarded for £17,500 with our client commenting.

“I had excellent service all the way through this experience. The communication between my case handler Sophie McGarry and myself was fantastic and really led to the positive experience I had. Thank you for all the empathy and understanding how I felt about everything. Really impressive service and I highly recommend. A special thank you to Sophie for her outstanding work”.

In response to the positive settlement, Sophie concluded:

“I hope that the compensation my client has received provides some form of recognition of the failure in this case and will assist her in moving on from this ordeal. This case highlights how a simple stress fracture can evolve and worsen when left undiagnosed and untreated, which can have a great impact on patients’ lives for a significant amount of time. It has been a pleasure dealing with this case and I am delighted with the outcome. I wish my client all the best for the future.”

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