Incomplete notes on femur fracture

Medical history

An elderly woman slipped over at a nursing home. The fall was gentle and no injury was apparent. Two days later, however, her hip remained painful and the GP was asked to visit.

His notes recorded that there was 90 degrees of flexion with pain on rotation, abduction and adduction. He thought a fracture unlikely since there was free movement, made a provisional diagnosis of osteoarthritis, and prescribed an anti-inflammatory.

One week later, the GP returned and noted increased pain with a tender swelling on the thigh. Since there was a history of spasm, he added a muscle relaxant to the prescription.

Ten days after the fall, the woman's son became concerned at his mother's condition and took her to hospital where an X-ray revealed a pathological fracture of the left femur. The woman was admitted for insertion of an intramedullary nail. Three weeks later she was discharged but found weight-bearing difficult and needed further hospital treatment. Her condition worsened because of an unrelated condition and she died two years later.

Negligence alleged

Soon after the death, the GP received a letter from a solicitor acting for the woman's estate. It claimed the failure to diagnose the fracture was negligent and caused unnecessary suffering.

The particulars of claim detailed the alleged injury caused:

  • extreme pain after the fall, made worse by the GP's advice to remain mobile;
  • loss of mobility due, in part, to muscle wasting following the fall;
  • reduced quality of life leading to depression.

Expert opinion

The MDU instructed solicitors to act on behalf of the member, and asked a GP expert to review the case notes. He found there was no record of whether or not the GP had checked for shortening of the leg nor for the ability to bear weight in the days following the fall. The GP's notes for the second visit showed no record of a further examination for leg movement.

He considered that these omissions made the case difficult to defend. A court would consider the available evidence - a history of increasing pain with swelling in the upper thigh - and would probably conclude that these justified referral for X-ray.

A consultant orthopaedic surgeon reported that the loss of mobility could not be blamed on the delayed diagnosis but that the patient had suffered unnecessary pain in the days before her admission.

The settlement

These opinions persuaded the MDU to offer a modest settlement. After some negotiation, £2,000 was accepted in recognition of the pain suffered. The legal costs significantly exceeded this sum.

This page was correct at publication on 01/10/2005. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.