Trust did not follow guidance for investigating hip pain

What happened

Mrs R fell and went to A&E. Staff X-rayed her shoulderand discharged her with painkillers. The radiologist, looked at the X-rays, saw a small wrist fracture and emailed A&E promptly with the result. A&E did not contact Mrs R as it should have done and so did not follow up on the wrist fracture.

Mrs R returned the next week as she had a pain in her groin. Staff X-rayed her pelvis and hip, but did not find any fractures. At the same time the doctor noticed the previous X-rays of her wrist and treated it with a plaster cast and pain killers.

About three months later she still had pain in her hip and her GP referred her to another hospital for a second opinion. Doctors diagnosed a pelvicfracture. Mrs R was advised to keep mobile and manage any pain with painkillers, as this was the only treatment.

Mrs R had physiotherapy care for wrist and shoulder painfrom the Trust but said she wasdischarged inappropriately. She complained to the Trust about this, and about the missed diagnoses of the wrist and pelvic fractures.Although the Trust apologised to her, she was not satisfied as she believed she had suffered 'life time damage' to her wrist.

What we found

We partly upheld this case. We found that the Trustacted in line with established good practice when treating Mrs P's wrist, which had a slight fracture, and in her physiotherapy care. We did not consider it a failing for the Trust to have missed the pelvic fracture, as it was extremely difficult to see, but it should have followed the guidance on investigating hip pain by carrying out a scan. Mrs R had probably experienced some additional pain, as well as anxiety about the cause, but her treatment would have been the same in any event.

Putting it right

The Trust apologised to Mrs R for failing tomake further investigations into her hip pain and for the anxiety and distress this caused her. It agreed to learn from the case and show how it would follow relevant guidance on fractures.