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'The failure to detect a fracture on an X-ray is the most common diagnostic error made in A&E,' says Michael Kelly, an orthopaedic trauma surgeon Shirley Johnstone had mixed feelings when the A&E doctor said the X-ray of her elbow showed no sign of a fracture. ‘It was a relief there was no serious damage. But I was in agony — I couldn’t move or straighten my arm, and felt I needed more than just paracetamol and a few days off work,’ recalls Shirley, 60, a chef from Great Wakering in Essex. The pain had begun suddenly when she stretched up to adjust a showerhead. ‘At first I thought I’d slept on my arm badly,’ she says. ‘But it was so painful, my partner advised me to get it checked.’ Six days after she was seen at A&E, Shirley received a phone call from the hospital. Doctors had reviewed the X-ray and there was a fracture after all, in the olecranon, the protruding bone that forms the tip of the elbow.
It was a mistake that, four years on, is still affecting Shirley’s life. For a second X-ray showed that the fractured bone fragments had moved 4mm in the intervening days. Her arm was put in a cast, then a week later she had surgery to pin the bone in place. But a year after the operation she developed a painful infection because fluid had built up around the fracture.
And three years later she still gets pain in the joint, especially in cold weather. ‘I had to have so much time off work, I was demoted and put on a lower wage,’ she says. ‘I’ve never got back on track.’ Shirley has never had a proper explanation for the delay in spotting the fracture. ‘One doctor told me, “I’m afraid sometimes these things get missed”,’ she says. Share Every year one person in 100 in the UK breaks a bone, and about half the 20 million or so visits to A&E involve having an X-ray, mostly to check for bone injury. But research suggests that thousands of patients walk out of A&E with doctors having failed to spot their fracture. ‘Numerous studies have shown that failure to detect a fracture on an X-ray is the most common diagnostic error made in A&E,’ says Michael Kelly, consultant orthopaedic trauma surgeon at North Bristol NHS Trust.