Decision Report 201200901

Summary

In December 2011, Miss C attended a hospital accident and emergency department (A&E) with an injury to her little finger. She was reviewed and

x-rayed, and diagnosed with a probable dislocation at the first knuckle in the finger. The x-rays showed a small fragment of damaged bone, suggesting damage to the ligaments on the sides of the joint and some damage to the soft tissues around the finger. Miss C's finger was immobilised by strapping, and she was reviewed at the fracture clinic the next day. The doctor there confirmed that she had a type of fracture that occurs when a fragment of bone tears away as a result of physical trauma, and said that her finger should be immobilised for three weeks. Two weeks later Miss C was reviewed by another doctor. He said that two joints in her finger were becoming stiff and referred her urgently for physiotherapy. She saw a physiotherapist that day. Miss C said that when the physiotherapist manipulated her finger she felt sudden and immediate pain, and after a minute of treatment fainted with the pain. She went to A&E again several days later complaining that the physiotherapy treatment led to an injury to her finger. She complained to us that because of this she needed a further operation which resulted in her finger becoming permanently injured.

As part of our investigation, we took independent advice from a medical adviser. The adviser said that the action taken was correct for a patient three weeks after an injury in which the joints and fingers have become stiff. They noted that the clinical notes for Miss C's attendance suggest that there was stiffness and, crucially, do not mention any abnormal positional deformity in the joint that would suggest the possibility of a secondary deformity developing. Leaving the fingers stiff for longer would have increased the risk of permanent stiffness. We concluded that the doctor's referral to physiotherapy without first taking an x-ray was reasonable, and noted that it was not possible to determine when Miss C sustained the injury about which she complained.