Expert Opinion 14 Dec 2018

Is It Always Negligent To Miss a Scaphoid Fracture?

Written by Morgan Lister

Fractures of the scaphoid, a small bone on the thumb-side of the wrist, can be difficult to diagnose. This is especially the case immediately after injury.

Missed fractures and dislocations are the cause of several legal claims. Whether you have a claim for a clinician missing a scaphoid fracture will come down to what investigations were carried out.

Symptoms of a Scaphoid Fracture

A scaphoid fracture usually happens after falling onto an outstretched hand. Symptoms include:

  • Pain/swelling between the base of the thumb and the wrist
  • Pain when trying to grip or hold something
  • Pain when moving the wrist or thumb

HOW IS A SCAPHOID FRACTURE DIAGNOSED?

When you presented with your injury three enquiries should have been carried out:

  • History: You should have been asked to explain how the injury was caused. This gives an idea of the level of force and the ‘direction’ of the injury.
  • Physical Examination: A proper physical examination must be carried out. They should have looked at the location of the pain/swelling/bruising. They should have asked when the pain increases or decreases and whether there is any loss of movement.
  • X-rays: If a fracture is suspected, x-rays should have been taken. In the case of a suspected scaphoid fracture, x-rays from four different angles should be taken.

A scaphoid fracture might not be visible on x-rays until 10 days after the initial injury. If it is not seen on the first x-ray, you should be x-rayed again in 10 to 14 days or a MRI or have a CT scan.

What is the Treatment for a Scaphoid Fracture?

Treatment depends on the location of the fracture, the type of the fracture and how long ago the fracture occurred.

If the fracture is ‘non-displaced,’ meaning the bone is still where it should be, it can usually be treated successfully with a cast.  In some specific fractures or if the fracture is ‘displaced,’ meaning the ends of the bone have shifted, surgery might be more appropriate.

If there is doubt then an opinion of a more senior clinician, or an orthopaedic specialist, should be sought as soon as possible. Otherwise, your wrist should be put into a splint and you should be referred for review in the next fracture or emergency department clinic.

Scaphoid fracture claims

Failing to diagnose a scaphoid fracture, or a delay in treatment, can have potentially devastating effects – including non-union of the fracture, death of bone tissue (due to a lack of blood supply) or potentially fusion of the wrist.

In answer to the question in the title – no, it is not always negligent to miss a scaphoid fracture. However, if the correct investigations were not carried out then there may be a claim to investigate.

If you would like advice about a claim, speak to Enable Law’s specialist clinical negligence solicitors in confidence today by clicking here.