The Newcastle Upon Tyne Hospitals NHS Foundation Trust

3. Mrs A complains the Trust failed to identify a fracture in her left humerus bone.

4. As a result of this, Mrs A says she felt extreme pain as she was continuously told to keep moving her arm. She says she was left feeling depressed as no one believed her arm was broken and she was in pain much longer than she needed to be. Since the fall, Mrs A says her arm is still injured and not fully healed. She cannot raise her arm to shoulder height and suffers with limited movement. She was left incapable of dressing herself, cooking and doing other normal everyday tasks. Her husband and elderly parents had to take time off work to help her daily. She also says she was scared to go out alone in case she fell again.

5. As an outcome to this complaint, Mrs A would like service changes and a financial remedy of £1,200.

6. Mrs A suffered a fall at home in October 2023. She attended the Emergency Department at the Trust the same day. The Trust undertook an X-ray and told Mrs A there were no breaks. The Trust advised Mrs A to keep moving her arm to prevent it seizing up.

7. Following appointments with her GP, Mrs A attended physiotherapy in January 2024. Mrs A was given exercises to do by the physiotherapist, but she explained she was in immense pain. The physiotherapist then requested for an MRI to be carried out. After the MRI at another hospital, it was determined she had a two-inch fracture to her left humerus bone (the bone in the upper arm).

12. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any indication that something has gone wrong.

13. Mrs A complains the Trust failed to identify a fracture in her left humerus bone. In response to the complaint, the Trust explained it was possible there may have been an un-displaced fracture on the initial X-ray. An un-displaced facture is where the broken ends of the facture remain aligned and in position, whereas a displaced facture is where the ends are not aligned. The Trust said Mrs A definitely did not have a displaced fracture on the X-ray.

14. The Trust undertook the X-rays at an out of hours radiology department as it was after 5pm on a Friday. Our adviser has explained X-rays such as Mrs A’s are usually interpreted by emergency department doctors and advanced practitioners (as happened in this case) and reported by radiology staff on the next working day. This is in line with the Radiology Standards.

15. The Trust took three views of Mrs A’s shoulder. Our adviser commented that this was more than usual practice (they explained most departments only do two). This maximised the chance of identifying a fracture.

16. The Trust’s view of the X-ray both at the time of the events, and during a re-review as part of the complaint response, did not identify a fracture. Our adviser has also reviewed Mrs A’s X-rays, and they have confirmed there was no displaced fracture of the humerus bone visible.

17. The Trust advised Mrs A to take pain relief and continue to move her arm, and to contact her GP or self-refer for physiotherapy if the pain was not settling.

18. Our adviser informed us further imaging for these kinds of injuries is dependent on patient re-presenting when symptoms fail to improve. This is because it is rare to have a missed fracture and even rarer to have one requiring different management. This is shown in the Emergency Medicine Study, which compared an X-ray to a CT scan. It found an X-ray had a chance of being correct when no fracture seen of 96% of the time.

19. We do not want to dismiss how Mrs A is feeling. We understand she has experienced a very difficult time with the pain she has had to deal with and the effect this has had on her life.

20. The Trust appears to have acted in line with relevant guidance in how it conducted and reported Mrs A’s X-rays. Even though the X-rays did not show the fracture, we do not think this indicates there was a failing in the Trust’s actions.

21. Due to the reasons outlined above we will not consider her complaint further. We hope we have explained our decision clearly.

1. We have carefully considered Mrs A’s complaint about The Newcastle Upon Tyne Hospitals NHS Foundation Trust (the Trust). We have seen no indication the Trust did anything wrong in the actions it took providing care to Mrs A.

2. We understand how Mrs A has been affected by the complaint issues she has raised. We therefore recognise our decision may be disappointing.