We have been acting for a client (aged 57) in connection with a clinical negligence claim against the Doncaster Royal Infirmary arising from treatment he received in their A&E Department during October 2018.
Briefly on 01 October 2018, he attended A&E at the hospital following an accident at home. He had injured his right foot when he fell some 10ft off a roof. He was unable to weight bear and noticed swelling in his right ankle.
Following an x-ray, our client was advised that there was no bony injury but he had sprained his ankle. He was discharged and advised to return to the hospital within 48 hours if he was still unable to weight bear.
Later on the 03 October 2018, he returned to A&E due to ongoing pain in his right foot, swelling, discolouration and he was still unable to weight bear. He was reassessed to include a doctor reviewing the x-ray taken earlier and he was reassured he had a sprain. He was advised to return if his foot got worse.
On the 10 October 2018, his GP referred him to the Montague Hospital for another x-ray. This took place on 24 October 2018 but once again, he was reassured his foot was normal, showing no bony injury.
Due to his continuing symptoms, on the 14 November 2018, he saw a Consultant Orthopaedic Surgeon as a private patient at another hospital, who arranged a further x-ray and he was advised that he had in fact a Lisfranc injury. A subsequent CT scan confirmed metatarsal fractures and soft tissue damage consistent with his accident at the beginning of October. He then underwent a primary fusion procedure.
In early 2019, the cast was removed from his foot. He underwent physiotherapy and was given a walking boot. At a final review during April 2019, four months post surgery, it was noted he was doing well, the wound was healing and he had no neurological symptoms. He still continued to suffer some mild discomfort in his foot.
BREACH OF DUTY
Our expert was not critical of the care our client received at hospital on 01 October 2018. It was however our case our client had received sub-standard care on the 3 and 24 October 2018 in that the hospitals had:-
- Failed to refer the client for a CT scan of his right ankle or for further advice from an orthopaedic surgeon and/or follow-up at a fracture clinic;
- Ignored clear signs of significant injury in the client’s right ankle;
- Incorrectly diagnosed the client with a sprain to his right ankle, notwithstanding the client’s continued complaints of swelling, bruising, tenderness, and an inability to weight bear;
- Failed to diagnose the client with a Lisfranc fracture sufficiently promptly or at all;
- Caused a delay in diagnosis of the client’s Lisfranc fracture;
- Delayed operating on the client to treat his Lisfranc fracture; and/or
- In all the circumstances, provided negligent clinical advice and opinion to the client, caused unnecessary pain, suffering, and loss, and failed to exercise the reasonable skill and care required in treating the client.
- Had the client’s Lisfranc fracture been appropriately suspected on 3rd or 24th October 2018, the client’s foot would have been placed into a boot. The client would have been seen by an orthopaedic surgeon within 3 – 4 days and referred for a CT scan. This would have been performed either on the same day or within 7 days.
- On balance, the CT scan would have revealed minimally displaced fractures to the midfoot consistent with a Lisfranc injury. The client’s diagnosis would have been made sooner than it in fact was.
- On balance, the fractures would have been considered unstable and the client would have been recommended and undergone early surgical fixation of the unstable joints. The client would subsequently have required 6 – 8 weeks in a cast, rehabilitation with a boot, and physiotherapy.
- The client would have avoided walking on an unstable fracture for a period of 4–5 weeks and would also have avoided the continued pre-operative symptoms in his foot. On balance, he would have had a long-term outcome which was 10–15% better than the client’s current outcome.
- As a result of the hospital’s negligence, the client suffered a delay in undergoing surgery and 4–5 weeks of additional fracture-related symptoms.
- As a result of the delay in conducting surgery, the client’s outcome is now 10– 15% worse than it would have been but for the negligence. The client continues to experience discomfort in his foot, particularly if he stands on the outside of his foot, when walking for prolonged periods, and when weightbearing for extended periods of time. He is unable to run.
- The client has required orthotic aids to relieve his symptoms.
- There is a 20% risk that the Client will require fusion surgery in future.
On obtaining supportive reports from an A&E Consultant on breach of duty and Orthopaedic Consultant on causation, a formal Letter of Claim was sent to the Hospital Trust responsible for both hospitals. In their Letter of Response, liability was denied. Proceedings were then issued and served on the Trust. Offers were then exchanged between the parties and eventually an offer was made by the Trust which we could recommend to our client.
S J Edney solicitors obtained compensation of £12,500.00 for this client during 2021
SOLICITOR’S COMMENT ON LISFRANC INJURY CLAIMS
Lisfranc (midfoot) injuries result if bones in the midfoot are broken or ligaments that support the midfoot are torn. The severity of the injury can vary from simple to complex, involving many joints and bones in the midfoot.
In our experience, these injuries are often missed or mistaken for a simple sprain. Patients who attend A&E with swelling and tenderness around the midfoot should always be suspected of having such an injury.
It is our view that such an injury should never be missed. Although they are notoriously difficult to identify on conventional x-rays, by using a standing x-ray or CT scan, will often demonstrate the subtle malalignment of the midfoot bones and changes in the foot to make this diagnosis.
If a diagnosis is either made or suspected, the patient should be referred to the Fracture Clinic straightaway for the injury to be investigated and treated either conservatively or by surgery.
Lisfranc injuries are often diagnosed late but even if they are diagnosed and treated appropriately, patients will often be left with residual discomfort in the midfoot after conservative or operative treatment which makes these cases difficult to value. Unless there has been some displacement of the bones or ligaments during the delay in diagnosis, the claim will have only a modest or possibly, no value as the patient has not suffered any harm by the delay in diagnosis.
If anyone suspects there has been a delay in diagnosing and/or treating a Lisfranc injury, they should contact us for advice on whether they have a claim.
We act for all our clients on a no win no fee basis.