Delay in diagnosis – Scaphoid Injuries

Scaphoid are quite easy to sustain – usually they result from falls onto an outstretched hand.  However, they are more difficult to diagnose.  That said, there is one “giveaway” symptom which usually indicates at least a likelihood of a fractured scaphoid and that is tenderness in the patient’s “anatomical snuff box”.  The anatomical snuff refers to an area of skin at the base of the thumb overlying the scaphoid bone, one of the eight carpal bones of the wrist.  Bony tenderness in this area indicates the possibility of a fracture to the scaphoid bone, the most commonly fractured carpal bone in the wrist.

It is well recognised that fractures of the scaphoid may not be revealed on the initial X-rays and therefore routine practice governs that patients with possible scaphoid injuries are treated cautiously.  The standard practice for assessing a wrist injury would include documenting the presence or absence of tenderness and swelling in the anatomical snuff box.  Not to document the presence or absence of tenderness in this area would be considered substandard.  A review of the Accident & Emergency Department records by one of our clinical negligence team would usually quickly reveal whether a scaphoid injury has been ruled in or out or even considered.

In those patients where there is anatomical snuff box tenderness but X-rays are normal, then review of symptoms at 10 to 14 days is required and the wrist should be splinted in the meantime to avoid further possible damage.  If following initial assessment or on review the X-rays reveal a fracture of the scaphoid then plaster immobilisation and orthopaedic review as an out patient would be standard therapy.  Sometimes surgery is necessary in order for the bone to heal properly.

We have settled numerous claims relating to the delayed diagnosis of a scaphoid fracture.  Delays can sometimes lead to a non-union of the fracture and ongoing, sometimes lifelong problems.  We have a register of experienced surgeons on hand whom we can approach to comment upon the standard of care you received whilst in hospital.  If you feel you suffered as a result of failure to diagnose your scaphoid fracture soon enough, don’t delay – telephone and speak to one of our clinical negligence team today on 01633244233