Bakur A Jamjoom1, Tim R C Davis2. 1. Department of Trauma and Orthopaedic Surgery, Queens Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK. Electronic address: bakur.jamjoom@nhs.net. 2. Department of Trauma and Orthopaedic Surgery, Queens Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK.
Abstract
BACKGROUND: The "missed" scaphoid fracture is a common cause of litigation. This study investigates why a series of scaphoid fractures involved in medical negligence litigation were missed. It also assesses how many might have been detected if MRI had been used to assess all suspected scaphoid fractures with normal X-rays, as suggested by National Institute for Health and Care Excellence (NICE). METHODS: Medical reports on 52 medical negligence cases of missed scaphoid fractures were reviewed. Complete sets of hospital and GP records and X-rays had been reviewed in every case. RESULTS: The recorded mechanism of injury was consistent with a scaphoid fracture in 41 (79%) cases. There was no record of an examination for scaphoid tenderness in 37 (71%) cases. Scaphoid tenderness was assessed and not found in 10 of 15 cases. No X-rays were obtained in 13 (25%) cases, and a scaphoid fracture was only suspected, resulting in scaphoid series X-rays being performed, in only 3 (6%) cases. In only 5 (10%) cases was there a record of the patient being advised to return if the wrist remained painful. CONCLUSIONS: Most of these scaphoid fractures were missed due to failure to consider the possibility of a scaphoid fracture and search for clinical signs of this injury. Some were missed due to failure to detect (or absence of) tenderness over the scaphoid bone. As a scaphoid fracture was never considered, or excluded by clinical examination, in 49 of the 52 cases, a policy of obtaining MRI for all suspected scaphoid fractures would only have detected three of 52 (6%) fractures. Improved awareness through better education is required to reduce the number of missed scaphoid fractures.
BACKGROUND: The "missed" scaphoid fracture is a common cause of litigation. This study investigates why a series of scaphoid fractures involved in medical negligence litigation were missed. It also assesses how many might have been detected if MRI had been used to assess all suspected scaphoid fractures with normal X-rays, as suggested by National Institute for Health and Care Excellence (NICE). METHODS: Medical reports on 52 medical negligence cases of missed scaphoid fractures were reviewed. Complete sets of hospital and GP records and X-rays had been reviewed in every case. RESULTS: The recorded mechanism of injury was consistent with a scaphoid fracture in 41 (79%) cases. There was no record of an examination for scaphoid tenderness in 37 (71%) cases. Scaphoid tenderness was assessed and not found in 10 of 15 cases. No X-rays were obtained in 13 (25%) cases, and a scaphoid fracture was only suspected, resulting in scaphoid series X-rays being performed, in only 3 (6%) cases. In only 5 (10%) cases was there a record of the patient being advised to return if the wrist remained painful. CONCLUSIONS: Most of these scaphoid fractures were missed due to failure to consider the possibility of a scaphoid fracture and search for clinical signs of this injury. Some were missed due to failure to detect (or absence of) tenderness over the scaphoid bone. As a scaphoid fracture was never considered, or excluded by clinical examination, in 49 of the 52 cases, a policy of obtaining MRI for all suspected scaphoid fractures would only have detected three of 52 (6%) fractures. Improved awareness through better education is required to reduce the number of missed scaphoid fractures.