What is a scaphoid fracture?

The scaphoid is one of the small bones which make up the wrist. It is located on the thumb side of the wrist. It is an important bone for movement and stability of the wrist. The scaphoid can be injured by a fall onto an outstretched hand, by a blow to the wrist or from punching.

Why are scaphoid fractures often missed or misdiagnosed?

Unfortunately, scaphoid fractures can get missed, often by those working in the front-line services such as GPs and in Accident and Emergency.

It can be difficult to see scaphoid fractures on an x-ray, especially straight after the injury, it is therefore important that proper examination is carried out. If a fracture cannot be visualised on an x-ray, a patient should be advised of the difficulties in diagnosing scaphoid fractures and told to return if the symptoms persist.

Examination should include:

  • History – Taking a detailed history from the patient of how the injury was caused and when;
  • Physical examination – To identify the location of any pain, swelling or bruising. Assess whether pain increases/decreases with movement and if there is any loss of movement. Checks of the hand, wrist and thumb/fingers should be made. The anatomic snuffbox in particular should be checked;
  • X-rays – Should be taken from different angles.

You may be able to pursue a claim for medical negligence if there was a failure to perform reasonable examination of the hand/wrist and an x-ray or a failure to advise of the difficulties in diagnosing scaphoid fractures and told to return if the symptoms persist for further x-rays.

X-rays taken at a later date often show a fracture more readily, so further investigations may be required to confirm the presence of a fracture.

On the other hand, if a radiographer fails to detect a scaphoid fracture when it is clearly visible on the x-ray, there may have been an unreasonable delay in diagnosis.

What happens if a scaphoid fracture is left undiagnosed and untreated?

If a scaphoid fracture is detected at the right time and treated you can expect a recovery time of approximately 12 weeks, usually without surgery.

However, if treatment is delayed, recovery time can be in excess of 6 months, with an increased risk of non-union, possibly requiring surgery or multiple operations.

It is also important to be aware that if the scaphoid bone is not receiving as much blood, because the fracture has interrupted the supply or indeed closed it off completely, the scaphoid bone will become more fragile and lead to other problems within the wrist, such as non-union of the fracture, avascular necrosis (part of the bone dies off), and arthritis. These conditions can have long term consequences.

Making a claim

It may be possible to make a medical negligence claim if there has been a delayed or missed diagnosis of a scaphoid fracture.

For free confidential advice about making a medical negligence claim please contact a member of our team on 0113 284 5000 or clinneg@isonharrison.co.uk

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