£230,000 settlement for clinical negligence – claim for injuries sustained as a result of a missed fracture in A&E 

Our client v an NHS Trust.
Year of incident: 2016
Date of Settlement: 2024
Acting: Scott Haslam, clinical negligence director at Wake Smith Solicitors

 

Facts:

The Claimant fell on an icy footpath in December 2016.  She sustained an injury to her left ankle, with associated swelling and bruising. She did not seek medical attention at the time as she thought she had merely sprained her ankle.

Whilst the swelling and pain initially reduced, she struggled to walk on her left ankle and was noticeably limping, with increasing pain, so attended A&E at a regional hospital in early February 2017. She was told she had suffered a soft tissue injury to her ankle and was discharged. The Trust said the diagnosis of a soft tissue injury was reasonable and that there was no need to x-ray.

Her left ankle remained painful, with intermittent swelling, so she saw her GP on 13 February 2017 who diagnosed suspected plantar fasciitis and she was given analgesic therapy.

The Claimant persevered with her symptoms as she thought there was no serious underlying injury, however her symptoms became more pronounced in late April / early May 2017.

She went back to her GP in June 2017 about the ongoing pain and swelling and was referred for an x-ray of her left ankle, the next day. The results indicated fractures to her tibia and fibula. The original report suggested the appearances were in keeping with stress fractures. The actual nature of the fractures and their appearance on the imaging became a significant issue in the claim.

After subsequent physiotherapy and persistent symptoms, she was advised to undergo surgery to her left ankle.  In April 2018, she underwent left complex hindfoot reconstruction, including open ankle fusion and iliac crest bone grafting.

This was initially thought to have been successful, but her condition failed to improve. Further imaging in November 2018 revealed the metalwork had failed and her foot appeared to be in severe valgus. She was consented for left revision ankle fusion to tibiocalcaneal fusion on 05 March 2019. Whilst the ankle fusion was ultimately successful, her symptoms did not improve.

Unfortunately, she experienced a fracture to her right ankle when she fell, at home, in September 2021. She was wearing a left walker boot as a result of the injury to her left ankle. As she tried to turn, her left foot (in the walker boot) didn’t turn causing her to lose her balance, fall and injure her right ankle.

She was admitted to hospital and required multiple surgical procedures to treat her right ankle fracture, and ultimately underwent a right ankle fusion in November 2021.  This was successful and the joint was deemed healed by March 2022.

Consequences:

• A delay in diagnosis of a fracture of her left fibula.
• Allowed to develop an insufficiency fracture of her left tibia with significant collapse of the ankle joint and valgus deformity, needing more complex surgery and revision surgery.
• Right ankle surgeries
• Ongoing ankle pain
• Regular pain relief every day
• Use of an air boot and padded shoe during the day, use of crutches or frame when outside the house
• Lack of confidence
• Significant restriction and reduction in mobility outside since the left ankle injury and inside relying on others
• Chronic post-surgical or post-traumatic pain syndrome
• Measurably increased risk of impact upon other joints, typically her left knee or midfoot.
• Change in behaviour - Stopped shopping physically, converting instead to online shopping, stopped socialising including theatre trips
• Mixed Anxiety and Depressive Disorder due to the physical injuries causing significant psychological stress and having a detrimental impact on her quality of life.

Current condition:

She experiences significant pain daily and has experienced a reduction in her ability to mobilise as a result. She relies on assistance from others with some tasks around the home, and has difficulty navigating stairs.

As a result of the injury to her left ankle, and the impact this had on her mobility, she experienced a Mixed Anxiety and Depressive Disorder. This improved such that she no longer had a recognised psychiatric disorder but she continued to experience mild symptoms of anxiety and depression as a direct result of the alleged negligence.

Following the injury to her right ankle, she experienced a further psychiatric injury due to her psychical symptoms and restrictions, namely a further Mixed Anxiety and Depressive Disorder.

Over the 18-21 months thereafter, and as a result of ongoing adjustment and adaption to her physical condition following the right ankle injury, her symptoms reduced.

Expert evidence:

We instructed experts to prepare reports for the client in the disciplines of:

• A&E
• Radiology
• Orthopaedics
• Pain Management
• Care / OT
• Orthotics
• Psychiatry

Admission of liability:

It was the Claimant’s position these injuries resulted from, and was a foreseeable consequence of, the injury to her left foot. The Trust denied this, arguing that an x-ray had been unnecessary when she first attended A&E, and that even if she had been diagnosed at that stage, she would still have required surgery to the same extent.

The Trust settled the case, accepting liability, ahead of a Trial scheduled for 2025. The settlement figure reflected this.

The Proceedings:

Settled out of court.

Settlement:

The claim settled for a value of £230,000.

We have a wealth of experience in resolving disputes for those who have suffered a medical injury from Private or NHS treatment including:

• Birth & Gynaecological Injuries
• Surgical Error (Including Cosmetic Surgery)
• Misdiagnosis / Misprescription /Medication error
• GP Negligence
• Fatal Accidents and Inquests
• Sepsis
• A&E Claims
• Care home neglect

For further information, or for specific advice please contact our leading clinical and medical negligence team on 0114 266 6660.