Hip conditions and treatments
As someone who required a right total hip replacement at the age of 38 and a left total hip replacement on the horizon, I am very aware that any negligence in this area that leads to additional injury, on top of a condition that is already painful and hard to manage, is very difficult to come to terms with.
There are many conditions leading to hip treatment that are not negligent in themselves, but failure to correctly diagnose and treat the need in good time, or even failure to perform the treatment to a reasonable standard can lead to a compensatable action in negligence. We can help with this. If you feel you have been subject to negligence, please contact us for a free initial review.
To try and explain where treatment may be negligent, it is important to remember what ‘negligence’ means in law. To summarise, this means that the clinician owed a duty of care to a patient, the care that was given was below a reasonable standard and that the care led to an injury over and above that which would have been seen in any event. It is also important to remember that the duty of care does not only apply to doctors. It also applies to paramedics, nurses, administration staff to an extent, physiotherapists, radiologists, and all clinicians who are involved in your care.
An example of a hip fracture and medical negligence
Let’s look at a practical example. A patient falls at home. They suffer from pain in the hip, knee or lower back. They cannot stand or walk. There is swelling and maybe bruising starts to develop. Perhaps the leg itself is at an awkward angle or seems shorter. All these symptoms would indicate a fracture and it is advisable that an ambulance is called as the patient will need to try and immobilise as much as possible so as not to make the fracture worse. The pain is likely to be of an extent that they could go into shock so it is important that they seek urgent attention.
This leads to your first clinical intervention. The paramedics and Ambulance Service. They would need to get to you within a reasonable time. That time is entirely dependent on the demand on the service and therefore a long wait is not necessarily a breach of duty. They would need to assess you not only for the leg injury, but also monitor for signs of other issues such as internal bleeding or shock. They must then move you carefully to ensure that the injury is not worsened as far as possible and get you to the hospital for assessment and treatment.
On arrival at the hospital, it is important that the patient is triaged correctly. This will entirely depend on their clinical presentation. The injury itself, if a simple fracture, may not require urgent surgery but complications such as shock and internal bleeding or potential nerve damage may well escalate the urgency. Generally, NICE (National Institute for Health and Care Excellence) Guidelines recommends that surgery for a hip fracture should occur within 48 hours of arrival at hospital. However, this could be expedited for reasons as above, or indeed perhaps delayed to bring other conditions under control to allow for safe surgery. Rushing into it may well be as harmful as waiting.
It is inevitable that radiology would be needed, whether this be X-Ray, MRI or CT Scan. A radiologist, or other trained individual, would have to report on the scan to confirm the existence and severity of the fracture. Failure to do this correctly would lead to a surgeon performing surgery with the incorrect information which may lead to complications. Alternatively, if a fracture is missed, the necessary treatment may not take place at all.
Any delay in providing treatment for fractures could well lead to ongoing difficulties that could have been avoided. The human body is amazing and will try to heal itself as best as it can. Therefore, if a fracture is not set in the correct position, it may then try to heal in the wrong place which would not only lead to problems in the bone, but also in the surrounding muscle and ligament system as these would be damaged.
Once the fracture is identified, the clinician would have to determine best treatment going forward. There are many different operations possible depending on factors including the severity of the fracture, age of the patient, the condition of the bone itself and taking into account level of mobility prior to the fracture. This could be surgery to pin and plate the hip with screws and rods to keep it in the correct position for optimal healing. It may be that partial hip replacement is required, replacing the bone that is damaged but not needing to replace the whole joint. A complete hip replacement may be necessary if the fracture is so severe the bone could not be salvaged.
During surgery there are many things for the surgical team to take into account and as such, it may not just be negligent performance of the surgeon to fix the bone that would give rise to a negligence claim. As well as the surgeon having to ensure he takes the necessary steps to protect the patient against injuries such as vein or artery nicks, nerve hyperextension, damage to muscle and tendons while performing surgery, others in the operating theatre must also provide a reasonable standard of care. These include nurses on hand and anaesthetists to ensure that you are safe under anaesthesia, not just by way of oxygen levels, etc but that you are positioned in such a way that no other injury is obtain such as hyperextension of an arm, etc.
Following surgery, the after care must also be of a reasonable standard. This includes both while in hospital and when discharged. Follow up appointments are necessary and important to ensure that the injury is healing as it should be and allow for any problems to be identified in good time.
Physiotherapists owe a duty of care to ensure that they provide treatment that will not worsen any condition and potentially to identify any issue that needs further follow up. GPs should be aware of history when re-presenting with any future problems in that area. Failure to take these into account may well be a breach of duty.