Samantha, 18 years old, Cornwall

Samantha was playing football when the ball struck her right hand forcing it backwards resulting in a hyperextension injury of the wrist. She had just started her university degree.

Two days later Samantha attended A&E at her local hospital as the pain in her wrist was not improving. She was seen by a junior doctor who checked for a possible scaphoid fracture by performing three so-called ‘scaphoid tests’. As he found none of these were positive, he ordered a plain X-ray of the wrist rather than specialist scaphoid views. On review of the X-rays, no bony injury was seen and a diagnosis of a simple wrist sprain was made. Samantha was discharged with instructions to mobilise the wrist.

A consultant radiologist later reviewed the X-rays and again no bony injury was seen. This was not surprising as a scaphoid fracture will not show up on a plain wrist X-ray.

Ongoing pain

Eight months after the initial injury Samantha eventually saw her GP as the pain in the wrist was persisting and she was experiencing difficulty in pursuing her degree course because of the reduced range of movement in the wrist. The GP immediately suspected a non-united scaphoid fracture and ordered scaphoid X-rays of the wrist. These showed “a fracture of the proximal pole of the scaphoid”, which had not healed.

Samantha was referred to a consultant orthopaedic surgeon and she underwent a complex operation with bone grafting 13 months after the initial injury. Unfortunately, this was unsuccessful and she had a further operation a year later. This again was not successful and after another year a ‘last-ditch attempt’ at surgery was made to get the scaphoid fracture to heal. She is currently awaiting the outcome of this.

Samantha has been significantly disabled throughout her university degree course and has only managed to complete it because of a great deal of support from the university and her family.

Negligence

Special scaphoid X-rays should have been ordered because there was some suspicion of a scaphoid fracture. If this had been done, on the balance of probabilities, the scaphoid fracture would have been identified and the wrist immobilised resulting in complete recovery. 90% of scaphoid fractures heal if treated early.

Samantha is still awaiting the outcome of her surgery before compensation can be calculated.