09 February 2011
Fractured Scaphoids: Common Mistakes in A & E
Rarely are 2 medical accidents alike, which makes it difficult to determine whether there was negligence. However one situation our team deals with regularly are missed fractured scaphoids.
Derek was a young goalkeeper. As he tried to save a goal, the ball hit his open palm at speed and his wrist felt painful. He went to Accident and Emergency where he was reassured it was just a sprain. After a year of putting up with nagging discomfort he was referred to the orthopaedic clinic where x-rays suggested a fractured scaphoid. He needed surgery to graft bone into his wrist but is left with discomfort and the risk of future arthritis.
The scaphoid is a small bone in the wrist. Falls onto the open palm or goalkeeper injuries can fracture it. The fracture is commonly missed in Accident and Emergency but to miss it is normally negligent. So what goes wrong? There are 4 pitfalls:
- The first is not to examine the wrist carefully.
- Putting a finger in the ‘anatomical snuffbox’ (the pit below the extended thumb) should be acutely painful if the scaphoid is broken.
- The second is to take the wrong x-rays.
- The images need to look specifically at the scaphoid.
- The third is to fail to splint the hand.
- The fourth (and most common of all) is not to tell patients to come back after 10-14 days.
- X-rays often do not show the fracture within the first week. It is only as the bone starts to heal that the fracture is visible.
Delay in dealing with fractured scaphoids often means surgery is necessary and the outcome is often worse.
Sadly this is a familiar scenario for our team. With such a common injury you would expect Accident and Emergency doctors to have this drummed into them. But then often the front-line doctors in Emergency Departments are the most junior, least experienced and highly pressurised. Perhaps this explains why we see so many of these errors.
Paul Sankey is a solicitor specialising in clinical negligence. If you or a member of your family have a clinical negligence enquiry please call our expert clinical negligence solicitors on 0800 916 9049 or contact us online and one of our specialist clinical negligence team will be in touch.