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A guide to Orthopaedic Negligence Claims

28 February 2019

What is the definition of an orthopaedic injury?

Put simply, an orthopaedic injury is any deformity/disorder/disease of the skeleton (bones) or its connecting structures, such as muscles, joints, tendons or ligaments.

What are the levels of orthopedic injury?

There are varying levels of injury to your bones from very serious to minor:

  • Fractures
  • Spinal deformities
  • Bone deformities
  • Bone infections
  • Need for amputation
  • Non-unions: failure of fractures to heal
  • Mal-unions: fractures healing in a wrong position
  • Spinal deformities

Injuries to muscles, joints, tendons (soft tissue connecting muscles to the bone) and ligaments (soft tissue connecting bone to bone) include:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Bursitis
  • Tendinitis
  • Strains
  • Sprains
  • Tears

Symptoms often include pain and inflammation (swelling).

Orthopaedic injuries which lead to medical negligence or medical malpractice claims can arise following avoidable complications in surgery, from incorrect advice from GPs or a missed or delayed diagnosis at A&E.

We have acted for cases involving:

Orthopaedic Malpractice Claims in A&E

If you end up in A&E after suffering a trauma injury, the first professional to ‘meet’ you will quickly make some decisions. The receptionist may possibly tell you to go to another facility, such as a minor injuries unit or your GP. A triage nurse may decide how quickly you need to be seen by a doctor. A nurse or doctor may decide if you need an x-ray or blood tests before someone else can diagnose and treat you.

If any of those decisions are wrong, the patient might lose critical time in a ‘window of opportunity’ to treat them optimally. As the doctors themselves say, ‘Poor Planning Precedes Poor Performance’.

We know of cases where the wrong decision was made about the emergency treatment of:

  • Fracture or partial dislocation of the lumbar spine
  • Epidural haematoma (collection of blood surrounding the nerves following trauma)
  • Compression of cauda equina (nerves in lower spine)
  • Herniated lumbar disk
  • Spinal stenosis
  • Scaphoid fractures
  • Ankle joint injuries
  • Knee ligament damage
  • Achilles tendon rupture
  • Hip fracture
  • Severed tendons in the hand
  • Shoulder dislocation
  • Crush injuries

Patients have ended up with lifelong disabilities which could have been avoided.

NHS A&E departments have brought the public’s attention to their very real concerns about underfunding and therefore understaffing of emergency care in our hospitals.

Sadly, this is likely to lead to shortcuts being taken and patients will end up with avoidable long term complications. If you need advice in relation to your own experience or that of a family member, do get in touch with a member of the specialist Barlow Robbins clinical negligence team.

Errors in Foot and ankle surgery

The human foot is complex. Each foot has 26 bones, 33 joints and more than 100 tendons, muscles and ligaments.

This means that people coming to hospital with pain in their foot or ankle might end up being offered all sorts of surgical treatment – fusion, realignment, tendon transfer, pins and plates – to treat toe problems, bunions, Morton’s neuromas, rheumatoid or diabetic foot problems, amongst other things. Sometimes things go wrong.

We are told that about a third of negligence claims against foot and ankle surgeons arise from treatment of ankle joint fractures. Surgeons use a classification system called Weber. A is infrasyndesmotic, B is trans-syndesmotic and C is suprasyndesmotic. It is critical to get it right and not to miss vital information on an x-ray.

Problems arise if the operation does not go far enough or deals with one problem but misses another. The patient might have to have revision surgery later or, worse, end up with a lifelong avoidable disability.

Commonly missed fractures in the foot and ankle include:

  • Lisfranc (dislocated fracture in the mid foot)
  • Anterior process of the calcaneum (heel bone)
  • Lateral process of the talus

Not all ‘mistakes’ by doctors are negligent. The law relating to medical negligence is complex and it is always important to get an opinion from an expert doctor in the field who is used to working with lawyers and the court.

For advice on whether your own case might merit compensation, please do contact one of the Barlow Robbins specialist clinical negligence team.

The following article details how we obtained a six figure sum for a lady who received negligent treatment following a fracture to her left foot.

Failure to diagnose Achilles tendon rupture

The achilles tendon is the strongest tendon in the whole body and lies at the back of your foot.

Typical injury happens on the football pitch. A player will feel a ‘pop’ and may fall to the ground. They will often believe they have been kicked – that’s what it feels like. They will limp off the pitch and end up visiting the hospital.

Achilles tendons can heal on their own over time but if they heal in a lengthened position the patient will get aching in the calf when walking and will find they have less power to push off. In other words they will have a disability. This can be prevented by repair surgery which is usually highly successful.

Doctors tell us that diagnosing a ruptured achilles tendon is quite easy, and relies on the clinician taking a proper history from the patient, examining the patient and diagnosing them doing a heel raise whilst standing on one leg.

Given that this is so straightforward, it is surprising that the diagnosis is so often missed. It is negligent not to carry out the right tests, fail to ask about what happened and send a patient home without offering them surgery.

Errors in Hip, Knee and Shoulder Surgery

Hip replacement surgery is a procedure in which a doctor surgically removes a damaged hip joint and replaces it with an artificial one (known as a prosthesis) often made from metal and plastic components. Knee replacement surgery involves replacing a damaged, worn or diseased knee with an artificial joint.

Common complications are:

  • Fractured femur from excessive force
  • Incorrect fitting/positioned prosthesis
  • Limb length discrepancy of over 3cm

Common shoulder complaints which lead to surgery are:

  • Impingement syndrome
  • Dislocation
  • Frozen shoulder
  • Torn or damaged tendons (rotator cuff tear)
  • Complex fractures

All of these surgical procedures can be performed safely and effectively but they do carry risks. Sometimes things can go wrong even when the surgeon as acted reasonably. You should ensure that you have been fully informed about all of the risks. As with any surgical procedure, your doctor should explain all of the options to you, setting out the potential benefits, risks, burdens and side effects of each option, including the option to have no treatment. If your surgeon makes an error that would not have occurred if the procedure is performed with reasonable care and skill you may well have a claim for negligence. You should seek specialist advice from our clinical negligence solicitors.

Read how our service made all the difference after negligent shoulder surgery.

Errors in Spinal surgery

It first helps to provide a very basic anatomy lesson of the spine.

The spinal column exists from the base of the skull to the pelvis. It consists of 33 vertebrae (interlocking bones) which are separated by discs. The spinal column houses and protects the spinal cord – the long tubular bundle of nervous tissue. The spinal cord itself is divided into five regions:

24 articulating (moving) vertebrae:

9 fused vertebrae (five in the sacrum and four in the coccyx or tailbone):

spinal cord diagram

Spinal surgery can be carried out by both orthopedic and neurosurgeons, although neurosurgery focuses on the central nervous system and orthopedic surgery tends to focus on the bone. Spinal surgery can be carried out for a number of reasons, for example to relieve compression on the spinal cord, stabilise the unstable or remove tumours.

Negligence can occur for a number of reasons:

  • Failure to image properly (x-ray/CT/MRI)
  • Failure to read imaging properly
  • Failure to operate in time
  • Excessive surgery
  • Wrong level surgery
  • Wrong side surgery
  • Inadequate surgery
  • Misplaced screws
  • Failure to correctly consent patients

From time to time, spinal surgeons will operate at the wrong level of the spine, and therefore on incorrect discs or vertebrae. Such errors will often lead to further surgery being required once the mistake has been realised.To look at the spine, surgeons use x-rays, CT scans and MRIs. X-rays are readily available but it is easy to miss things. CT scans are more detailed than x-rays but can sometimes be obstructed. MRI scans are the gold standard but are not as readily available and require careful interpretation. There are around 7 to 12 spinal surgeons at the nearest Major Trauma Centre (St George’s Hospital). If patients attend GPs, pain consultants, physiotherapists or chiropractors or even district general hospitals where there are fewer spinal surgeons, patients are reliant on timely referrals, on the correct pathways being applied and then a competent review of imaging by a competent surgeon. Do not be afraid to ask your surgeon about his or her training, practice focus, experience with whatever operation has been recommended, and whether you the patient have been presented all of the options that exist.

Spinal injuries include fracture of the spinal cord (complete and partial) and pressure on the spinal cord causing total or partial loss of blood supply.

The extent of spinal cord injury is defined by the American Spinal Injury Association (ASIA) Impairment Scale (modified from the Frankel classification), using the following categories:

  1. No sensory or motor function is preserved in sacral segments S4-S5
  2. Sensory, but not motor, function is preserved below the neurologic level and extends through sacral segments S4-S5
  3. Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade of less than 3
  4. Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade that is greater than or equal to 3
  5. Normal: Sensory and motor functions are normal

These serious orthopaedic injuries often involve catastrophic and permanent disability and leave the injured person with a vast array of physical and psychiatric needs, including carers, case managers, rehabilitation, further medical treatment, house adaptations to single storey living and medical equipment. Very often, these injuries leave people unable to work which makes funding all of these things impossible. These can be very complex claims and not all are suitable for litigation. Please do seek our expert advice if you consider that you have a claim for negligence.

Failure to Diagnose Spinal Injuries

Conditions that may affect the spine are:

  • Osteoarthritis
  • Degenerative disc disease
  • Herniated discs
  • Bulging discs
  • Epidural haematoma (collection of blood surrounding the nerves following trauma)
  • Inflammation from trauma
  • Osteophyte (bone spur) growth
  • Degenerative scoliosis
  • Spondylolisthesis (vertebral slippage)
  • Tumours
  • Metastatic spinal cord compression (cancer that has spread)

These conditions can sometimes destabilise the spine and can cause the nerve roots in your spine to become compressed.
Nerves (also known as nerve roots) that branch off the spinal cord consist of:

  • 8 cervical nerves
  • 12 thoracic nerves
  • 5 lumbar nerves
  • 5 sacral nerves
  • 1 coccygeal nerve

The tapered lower end of the spinal cord near the first lumbar vertebra forms the conus medullaris and then the nerve roots from the lumbar and sacral levels continue to branch off the bottom of the cord like a "horse's tail" (named the cauda equina). Damage to these nerves at the end of the spinal canal (cauda equina) can cause permanent paralysis and incontinence.

Back pain is one of the most common neurological problems seen by GPs and A&E departments but failure to recognise the ‘red flags’ of cauda equina sydrome will almost certainly result in a claim. Our orthopaedic injury solicitors are very experienced in these types of claims. See how our team can can assist you under our dedicated cauda equina sydrome claims page.

For further advice on Serious Orthopaedic Injury, please call us on 01483 543210 or alternatively email one of our orthopaedic injury solicitors.

By Natalie Hirst