Medical Malpractice: Delay in Diagnosis of Dislocation - $500,000

Injuries alleged:Delay in diagnosis of lunate dislocation.

Amount of settlement:$500,000.00

Case Summary:
Plaintiff, a 21 year old man, presented to a local urgent care center after falling approximately 10 feet off of a ladder. Upon admission, he complained of right wrist pain. He was seen in consultation and treated by Defendant #1, who conducted an evaluation of his right wrist, which revealed moderate swelling. Defendant #1 also noticed a possible deformity, decreased range of motion, and right radial tenderness. An X-ray of plaintiff's right wrist was obtained, and Defendant #1 diagnosed a radial styloid forearm fracture. Plaintiff was discharged in a splint with instructions to follow up with an orthopedic surgeon the following week.

On his own, plaintiff went the following day to the orthopedic surgeon (Defendant #2) whose name he was given. While Defendant #2 saw and examined the plaintiff, he did not take X-rays of the plaintiff's right wrist nor did he request the X-rays that had been taken the day before at a local hospital. Instead, Defendant #2 accepted Defendant #1's diagnosis of radial styloid forearm fracture, removed the splint, and placed the plaintiff in a short arm cast. Plaintiff was instructed to follow up with Defendant #2 the following month, which he did. When plaintiff returned, the cast was removed by Defendant #2 and an X-ray was taken. Defendant #2 noted that the "radial styloid fracture has healed." Plaintiff was discharged from Defendant #2's care and instructed to wear a brace for approximately two weeks.

Two months later, plaintiff returned to see Defendant #2 complaining of a "stiff right wrist." Defendant #2's physical examination revealed "almost no range of motion of his right wrist." Another X-ray was taken, which showed a volar dislocation of the lunate in his right wrist, which had been missed by both Defendant #1 and Defendant #2. Defendant #2 noted that the lunate dislocation was "overlooked." Plaintiff was offered "free care" for surgery, which Defendant #2 offered to perform later that month.

More than three months after the initial dislocation, Defendant #2 performed an open reduction with internal fixation. The operative note of Defendant #2 indicates a "unrecognized volar dislocation of the lunate (which) has become a chronic problem resulting in pain and limited range of motion." Defendant #2 continued to treat the plaintiff for the next year and a half, during which time the plaintiff developed degenerative arthritic changes in the wrist and the beginnings of a slack wrist deformity. Finally, plaintiff left the care of Defendant #2 and sought a second opinion. This orthopod's records indicated, "He did not have surgery to relocate the lunate for approximately three months…unfortunately, predictably he has had a progression of his wrist pain, stiffness, and now degenerative changes in the wrist which caused him to have a limited range of motion and fairly significant pain with flexion, extension, wrist rotation…." This orthopedic surgeon advised that, "Unfortunately, his best option would be a wrist fusion," which plaintiff decided not to undergo given his age.

This case was resolved two months before the scheduled Pre-Trial Conference. Plaintiff was prepared to present the testimony of a board certified emergency medicine physician, who would have testified that Defendant #1's failure to diagnose the lunate dislocation on the day of the injury represented a departure from applicable standards of care in that the lunate dislocation was readily visible in the X-rays that she had ordered but not recognized. Plaintiff was also prepared to present the testimony of a well-reputed hand/wrist surgeon, who was prepared to testify as to the negligence of Defendant #2, which in his opinion included the failure to have obtained either the existing wrist X-rays taken the day before or perform his own on the day after the injury when the plaintiff saw him; failure to have recognized the lunate dislocation on the X-rays that he himself performed the following month when the plaintiff returned to see him; and the failure to have referred the plaintiff out for timely treatment by another orthopedic surgeon who specialized in the treatment of wrists. Plaintiff's orthopedic expert was prepared to testify that while lunate dislocations such as the one suffered by the plaintiff carries with it a real risk of developing significant arthritic changes, as was developed by the plaintiff, that the failure to have reduced the lunate for over three months greatly increased plaintiff's chances of developing the condition that he did.