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Case Study: Mismanaged Fracture of Humerus
Kathryn, 12 years old, Burnley
A young girl has successfully acquired £20,000 compensation after doctors mismanaged her humerus fracture.
Kathryn was 12 years old when she was knocked down by a car, injuring her right shoulder. She was taken to the A+E Department at Burnley General Hospital. An X-ray showed that Kathryn had suffered a displaced fracture of the neck of the right humerus. She was admitted to hospital for a manipulation under anaesthetic. No lateral X-rays had been taken.
Kathryn was taken to theatre, and underwent attempted manipulation of the fracture but it was unsuccessful and the shoulder became very swollen. She was sent home in a sling and was to be seen in the Fracture Clinic a week later, the plan being further manipulation under anaesthetic.
Kathryn was re-admitted and the further manipulation under anaesthetic was attempted. An unstable reduction was achieved with great difficulty. The fracture had become "sticky" and had to be broken and this caused further swelling. Two K-wires were inserted and it was thought an acceptable position was achieved. X-rays were taken at the end of the procedure but only an AP view was possible.
A few days later Kathryn was reviewed by the Consultant, who requested an open reduction and internal fixation (ORIF) of the fracture. At that operation it was noted that the biceps tendon was trapped in the fracture site. The reduction was described as "very very difficult" due to tight tissue. Great difficulties were encountered in reducing and maintaining the fracture in a good position. In the end, the position achieved was accepted.
Kathryn developed a wound infection, which required early removal of the wires. She continued to suffer from pain and stiffness in the shoulder and was ultimately referred to another Hospital for a second opinion, where a CT scan revealed an external rotation deformity of the head of the humerus.
Kathryn underwent further surgery 3 years later at the Royal Manchester Children's Hospital for an osteotomy of the right humerus, involving a bone graft from the hip.
The operation was successful in improving Kathryn’s range of movement, however she had some residual discomfort and stiffness and some reduction in movement in her right shoulder. She was also left with extensive scarring over the right shoulder and hip.
JMW Solicitors claimed that a total anatomical reduction of a fracture of the neck of the humerus in a child was not essential. Careful conservative treatment alone is likely to have achieved satisfactory reduction of Kathryn’s fracture. JMW Solicitors further argued that given the absence of lateral X-rays the degree of displacement of the fracture could not properly be assessed. Furthermore, it ought to have been known that achieving improved reduction via an open operation 19 days after the original injury would inevitably be difficult.
The Hospital felt that the fracture of the humerus, with the degree of displacement, was a difficult fracture to treat. A lateral X-ray was difficult to take in the A&E Department because of the degree of severe pain associated with the type of fracture, together with the degree of swelling. The Hospital contended that there was no need to take a lateral X-ray as the Claimant was to undergo manipulation under general anaesthetic. The hospital further denied that conservative treatment would have prevented the fracture from not uniting. They suggested that the biceps tendon was caught in the fracture site and as such it was unlikely that the fracture could be treated by conservative treatment alone. Finally, it denied that the decision to proceed to an ORIF was negligent. The hospital felt that Kathryn’s condition was a consequence of the severe nature of the original displaced fracture and was not due to the treatment provided.
However, eventually the matter was settled and Kathryn was awarded £20,000.00.