How A Mismanaged Ankle Injury Led To Complications And A Medical Negligence Claim

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The Law Of… Providing The Correct Treatment

What should have been a routine treatment for a fractured ankle developed into a case of medical negligence, leaving one young girl with a deformity and in a considerable amount of pain.

Sarah Chambers, a Medical Negligence Solicitor at Simpson Millar, handled the resulting claim and reveals how months of avoidable suffering led to a substantial settlement.

Fractured Ankle

A minor at the time of her accident, Megan Clare was hit by a bicycle in April 2009, damaging her ankle. She was taken to the local Accident and Emergency, where x-rays revealed she had sustained a fracture to her distal tibia and fibula – the point where a person's shin and calf bones meet the ankle joint.

Following a 4 night stay in hospital, during which time her fracture was treated with a below the knee Plaster of Paris (POP) cast, Ms Clare was discharged. Within 2 weeks the nature of the injury had changed.

Complications And A Valgus Deformity

Further x-rays showed there was evidence of valgus deformity. This is an orthopaedic term for a condition that arises when angulation occurs to a distal bone (one situated away from the centre of the body) at the joint, causing it to turn outwards from the body's midline. In the claimant's case, the ankle was affected, a problem which could've been curtailed if correctly treated at this early stage.

The medical professionals in charge of Ms Clare's injury accepted the existence of the deformity but didn't think it warranted additional treatment. Instead, remodelling was advised and a long leg POP, with knee flexion, was applied.

Over the course of the following year, the plaster was wedged as x-rays revealed a steady progression in the valgus deformity, with angulation increasing to 20 degrees. During this time, Ms Clare was also returned to a below the knee cast, with the hospital continuing to accept the presence of the deformity, but not perceiving it as being any threat to her quality of life.

By this time, the family of Ms Clare, who was still below the age of 18, had raised concerns regarding both the cosmetic and functional issues arising from the angulation of her ankle. In October 2010, a full 18 months after the initial accident, she began to experience pain in and around the fracture site.

A subsequent MRI scan revealed that the ankle was healing, which meant the valgus deformity was the source of the discomfort. The decision was finally made to get the problem fixed and Ms Clare was placed on a waiting list for corrective treatment.

Almost 2 years to the day that Megan Clare was hit by a reckless cyclist, she underwent Taylor Spatial Frame correction. The procedure involved the assembly of a precision built, steel framework fitted around the affected ankle. It was removed in August 2011 and an x-ray the following month showed that the alignment of her ankle had returned to normal.

Breaches Of Duty – The Allegations

A claim for medical negligence, on behalf of her daughter, was made by Ms Clare's mother, with Ms Clare herself assuming responsibility for the claim once she turned 18. Simpson Millar was instructed to handle the case and Sarah Chambers provided legal advice and representation.

Sarah alleged the following breaches of duty:

  • Following the initial x-rays taken on admission to Accident and Emergency, the hospital failed to effectively manage the claimant's fracture
  • Negligent acceptance of a 20 degree valgus deformity
  • Negligent assertion of Ms Clare's remodelling potential, in the light of a premature puberty detailed in her medical history, which limited the effect remodelling would have
  • Failure to address the 20 degree deformity as identified in successive x-rays following initial admission to Accident and Emergency.

It was argued that a responsible body of Orthopaedic Surgeons, recognising the limited potential for remodelling, would not have accepted the 20 degree deformity and instead prescribed surgical intervention at an earlier stage.

Causation – The Allegations

Had early action been taken to address the valgus deformity, Ms Clare would have undergone corrective surgery, which, on the balance of probabilities, would have involved a procedure to insert a plate and pins.

This would have spared her the ensuing months of pain, suffering and psychological distress that were caused by the hospital's negligence. It would also have negated the need for the more complex external frame procedure, only necessary because of the delay in treatment.

A Successful Outcome

A Letter of Claim was submitted to the hospital responsible for managing Megan Clare's injury and subsequent deformity. It was responded to with an admission that duty of care had fallen short on this occasion, with a failure to appropriately handle both the patient's welfare and injury since her initial attendance at A&E in April 2009.

The hospital also accepted that corrective surgery could have been avoided altogether had formal manipulation occurred at the time of presentation, although it argued that conservative treatment with a plaster slab was acceptable due to the risk of infection from open surgery.

The hospital also stressed that, once implemented, the eventual corrective procedure had been successful, with good alignment of the ankle meaning there would be no long term damage.

An offer to settle for £6,500 was made, which was considered reasonable but, due to the medical evidence we had obtained, at the lower end of the award scale for similar injuries. Ms Clare was advised by Simpson Millar to reject the first offer of settlement, a recommendation that proved to be effective when the hospital increased the value to £8,000.

The improved offer was accepted and settlement agreed on the 31st May 2017, a whole 8 years on from the collision with a bike that first injured Megan Clare.

Nothing Short Of Excellent

Extremely pleased with the performance of Simpson Millar and her legal representative, Sarah Chambers, Ms Clare commented:

"Simpson Millar provided continual and clear understanding throughout as to how my case was progressing. The service they offered was nothing short of excellent."



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