Missed fracture

...Mrs B could walk but an X-ray months later showed an undisplaced fracture...

Mrs B was descending her stairs one dark winter morning and missed the bottom step. She fell heavily against the banister and turned her ankle. Later that day she attended her GP surgery.

Dr N examined Mrs B and found extensive bruising in both her shoulder and right lower leg and foot. He noted that on entering the consulting room Mrs B appeared to weight bear well on the ankle but much of Dr N’s attention had been directed to the severe pain in the patient’s shoulder. Later in the consultation he did examine the ankle more thoroughly, palpating both malleoli and checking for ligamental laxity.

Dr N diagnosed soft-tissue injury in both the shoulder and ankle and advised Mrs B to take Ibuprofen and use an ankle support.

Two months later Mrs B returned to the surgery complaining of persistent pain on walking. Dr N had been rushed that day and gave the ankle a quick examination and found it slightly swollen in comparison to the left. Dr N again diagnosed soft tissue injury and advised her to continue with the Ibuprofen and the Tubigrip.

Four months went by and Mrs B appeared again at the surgery but this time saw a different GP. She still felt pain on walking any distance. The GP ordered an X-ray and later it was confirmed that Mrs B had an undisplaced fracture of the medial malleolus of the tibia.

Mrs B was referred to an orthopaedic specialist who recommended surgical fixation. A letter from Mrs B’s solicitors claiming medical negligence was received by the practice.

Analysis and outcome

MDDUS commissioned a report on the case. In his opinion the expert judged that given Mrs B could walk and, hence, weight-bearing it would have been reasonable not to have ordered an X-ray on her first visit. But in not referring Mrs B on her second visit – with the persisting pain and swelling of the ankle – Dr N’s care definitely fell below acceptable standards.

A decision was made to settle the matter with the member's agreement.

Key points

  • Ensure adequate attention is paid to all injuries in a trauma case.
  • Do not rush examinations.
  • Give careful consideration to persistent joint pain after injury.