Missed Fractures

Lee S. Goldsmith, M.D., LLB and Jordana S. Goldsmith, J.D.

I am frequently asked:  How is it possible to miss a fracture? 

My response:  Simple. At the time of the initial film the injury may not have been visible on the films.  

A fall may have occurred or the individual may have been in an automobile accident and suffered multiple injuries. In each of the cases, the individual is taken to the Emergency Room, seen, hopefully by an Emergency Room physician and sent for X-rays to be taken. In the case of the fall, the report is no finding of a fracture. In the case of the automobile accident, there may be a report of multiple fractures, but one or more than one fracture is missed. 

My second response: not so simple. The films are often read two times. First, immediately in the ER by an individual, who, depending on level of training, may not have the capability to read films that are with significant but subtle changes and the second by a radiologist who should pick up on what may be missed by the ER personnel. Unfortunately, sometimes the radiologist relies on the initial reading and does not completely and thourougly review the films. 

In the case of a missed fracture, the following are the possible scenarios leading to a medical negligence action:

First, the patient has contacted an attorney at a time when the fracture diagnosis has ultimately been made and the fracture treated.  We, as attorneys, start off with the advantage of knowing where the fracture was and the ultimate care that was necessary to treat the fracture. 

Second, we have to make a dertermination as to whether or not any of the practitioners deviated from the accepted standards of care. This is done by analyzing the care and treatment that was rendered from the date of injury to the date when the diagnosis was made. 

What information did the emergency room physician have? Does the record show that there were complaints from the patient in the area of the specific injury?  Did the emergency room physician send the patient for the appropriate x-rays?  Analysis of the record from the EMT’s and the Emergency Room show complaints relative to the injury.

[An example: Driver of an automobile in an accident where the front end of the car was severely damaged, pushing the engine into the dashboard. The patient suffered a fractured knee, which was diagnosed in the ER. What was not diagnosed was the fact that with the fracture of the kneecap, the femur bone was pushed back and led to a fracture of the patient’s pelvis.]

Ultimately the fracture is missed. A decision is made that the miss should not have occurred.

We then have the second question: What additional injury did the patient suffer as a result of the missed diagnosis?

There is no question that the delay in diagnosis in all cases resulted in a period of pain and suffering that might not have been necessary. However, then the diagnosis is made and the fracture treated, with no permanent injury to the patient. When that is the case, most attorneys would not pursue a claim for medical negligence as the resultant compensatory damages would be insufficient.

However, there are cases where the missed diagnosis does result in permanent injuries. When that occurs, there can and probably will be a claim for medical negligence. 

We have handled a number over the years and are currently investigating the consequences of a missed subluxation of a bone in a joint. 

Errors committed by professionals are repetitive.