Arkless v Betsi Cadwaladr University Local Health Board [2016] EWHC 330 (QB) (22 February 2016)

On 23 April 2009 C injured her wrist and attended the emergency department the following day; the clinical findings were:

“Saving a goal hypertext L wrist/hand. Tender + swelling to distal radius/wrist. ASB non tender no pain on axial compression. Pins & needles to ulnar nerve distribution but movements ok. Xray wrist.” (paragraph 5)

Scaphoid views were not obtained. No fracture seen, Futura splint fitted. The pain persisted. In February 2010 she was found to have an old scaphoid fracture.

The court referred to published guidelines: “In this case assistance as to reasonable medical practice can be obtained from a document entitled “Guideline for the Management of Suspected Scaphoid Fractures in the Emergency Department” published by the College of Emergency Medicine in September 2013…” (paragraph 15)

“…that it is essential in order to represent a reasonable body of medical practice for all three of the tests [tenderness: ASB, scaphoid tubercle, thumb axial compression] to be undertaken and for results to be elicited in respect of each of the three tests…” (paragraph 22)

The case turned on technique of clinical examination (paragraph 23).

Judgment for the claimant.