Decision report 201200308

Summary

Mr C suffered a hand injury while he was in prison. He was treated in hospital the day he was injured, when an x-ray showed he had a metacarpal fracture (an injury to one of the small bones in the hand). The hand was strapped up, and he was seen again around a week later, when another x-ray showed the position of the fracture to be acceptable. The doctor noted that Mr C's hand should remain in strapping until the next review appointment. The next month, Mr C complained to the board that his treatment had been inappropriate. He was concerned that strapping rather than a cast was used, and said that he remained in a great deal of pain. He said that his hand was swollen and becoming deformed, with the bone sticking out. Mr C had further appointments over the next three months, and after a CT scan was taken, a hamate fracture (an injury to a small bone on the outside of the wrist) was identified in addition to the metacarpal fracture. He underwent steroid injections for pain management, and was considering surgery.

After taking independent medical advice, we did not uphold Mr C's complaint, as we found that the management of his injury had been appropriate. We found that the use of strapping to allow him to continue to move his hand, rather than a plaster cast, was appropriate for this type of injury. We also found that the hamate fracture could not be detected easily from the initial x-rays due to its position. We found that the shape of Mr C's hand was not due to the bone sticking out, but rather due to the formation of callus (thickened skin) as the injury healed. We also found that surgery at an earlier stage would not have been appropriate because time had to be allowed for healing before surgery could be carried out. We did not uphold the complaint, although we did note some minor issues in relation to the board's response to Mr C's complaint, which we drew to their attention.