Negligent management of leg fracture at West Middlesex University Hospital
Deborah Nadel was instructed by Mr K* in relation to a claim for damages for medical negligence arising from treatment at West Middlesex University Hospital for a fracture in his right leg in 2016.
In June 2016, Mr K fell off a stool and fractured his right tibia and fibula. He received non-operative management at West Middlesex University Hospital before undergoing open reduction internal fixation surgery a few weeks later.
Mr K was reassured that the wound was healing despite expressing concerns about the external rotation of his foot. He remained in a cast throughout 2016 and started partial weight-bearing in January 2017.
Mr K continued to experience problems with mobility and pain in his right leg. A clinical report from September 2019, noted an external rotation deformity of the foot ranging from 25 to 30 degrees. Mr K was advised to undertake a corrective osteotomy procedure to address the malrotation of his leg but this was cancelled due to Covid and has yet to take place.
Mr K approached Fieldfisher more than 3 years after the date of surgery which meant he had difficulties arguing he was able to bring a claim within the relevant limitation period. Deborah contacted the hospital's legal team urgently and organised for the limitation clock to be stopped pending her investigation of a potential claim.
As part of these investigations, she instructed an orthopaedic expert who indicated that there were grounds to allege that West Middlesex University Hospital's standard of care in managing Mr K's fracture fell below an acceptable standard and was negligent.
Breaches of duty of care included:
Surgical negligence:
- Fixing the fracture in a position of external rotation beyond a reasonable range.
- Failing to recognize intraoperatively that the fracture was being fixed in an externally rotated position and correct it during the surgery.
Post-operative negligence:
- Failing to take plain x-rays showing the knee and ankle on the same view in the early post-operative period.
- Failing to recognize significant malrotation when x-rays were taken three weeks post-surgery.
- Failing to pay heed to and investigate Mr K's complaints of malrotation and act upon symptoms suggestive of malrotation.
The malrotation led to a prolonged and slow recovery, ongoing pain, stiffness, mobility issues, and a number of falls. Physiotherapy failed to improve his condition which now necessitates corrective osteotomy surgery.
With competent care, Mr K would have required a period of protected weight bearing and immobilization, leading to a full recovery within six months post-injury.
Mr K's ability to work has been affected and his capability to undertake domestic activities and physical recreational pastimes has been restricted.
Following investigation, Deborah wrote a Letter of Claim to the hospital urging them to admit liability. In their response, West Middlesex University Hospital alleged the claim was being brought out of time and was therefore barred. However, despite this they also admitted negligence in fixing the fracture in an unreasonably rotated position. They denied other allegations and the extent of persisting symptoms. The hospital offered an apology for falling short of their usual standard of care.
Despite the hospital raising the issue of limitation in its response, Deborah succeeded in negotiating a settlement for Mr K which it is hoped will enable him to undergo the corrective surgery and resume his normal activities following a period of recovery.
Mr K: "I would like to start by saying thank you so much for helping and seeing this case through. You have been absolutely awesome and I really appreciate everything you have done."
*name changed
For further information about hospital negligence claims or medical negligence claims, please call Deborah Nadel on 03304606750 or email deborah.nadel@fieldfisher.com.
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