13. Miss A complains her medical records show that after a car accident in January 2024, it is likely she had a shoulder fracture. She complains the Trust’s March 2024 report says there was no fracture. The accident is clearly a traumatising event for Miss A, and we are sorry to hear she still experiences pain and discomfort because of it.
14. When Miss A was first taken to the Trust directly after the accident, her shoulder was x-rayed as that is where she was experiencing the greatest amount of pain. The x-ray shows that the acromioclavicular joint (this is the joint that connects the collar bone to the shoulder blade) showed a normal alignment. There are mild degenerative changes and a small, rounded bone (known as an ossicle) within the joint. Ossicles are small bones which are separate from the main bones and can be present from birth or develop as the result of trauma or wear and tear.
15. It is important to note the shape of acute avulsion fractures on x-rays. These are usually thin and sharp bone fragments with indistinct edges, rather than small and rounded, as shown on the January x-ray. This suggests the Trust appropriately reported the January 2024 x-ray. Our adviser also said the January 2024 x-ray report findings are the same as what was found in h the review undertaken by the Trust on 4 March 2024.
16. Miss A told us that there was no mention of any ‘degenerative changes’ after the January 2024 x-ray. The RCR Guidance says a radiology report should be “actionable” in that the clinical question and important positives/negatives in the clinical context should be answered. Given the context of the x-ray was in relation to the trauma (the car crash) and was not querying degenerative changes, the reporting radiographer chose not to include any reference to those changes in the report. This is in line with the RCR Guidance.
17. The findings of the February 2024 ultrasound are recorded as ‘suspicious for an avulsion fracture.’ The ultrasound showed the small ossicle within the joint. Our adviser explained that ultrasound is less specific than x-rays in showing the overall shape of an ossicle as ultrasound waves cannot penetrate bone to show the underside of the ossicle. Therefore, this point should not have been raised in the February ultrasound report.
18. We note the report states, “…suspicious for an avulsion fracture.” While the finding was not a definitive one, we can understand how it led Miss A to believe that she did experience a fracture as a result of the crash. The previous x-ray report had not said there was evidence of a fracture so we can appreciate she would have been confused.
19. We can see that nine days later, Miss A had an appointment with a doctor of trauma and orthopaedics at the Trust where the outpatient letter shows that the doctor explained the x-rays show degenerative changes (referred to as Osteoarthritis in the NICE Guidance) and Miss A was given advice on the management of the issue.
20. This appointment was the first opportunity for the Trust to clear up the confusion and explain to Miss A that there was no fracture and that her pain resulted from Osteoarthritis in a joint in her shoulder.
21. The actions of the Trust in its reporting of the x-ray results and then confirming the diagnosis are in line with the RCR and NICE Guidance. As a result, there are no indications anything went wrong, and we will not take any further action on this complaint.
22. We hope that she is assured that the initial x-ray and subsequent reviews of that x-ray confirm that she did not have a fracture as a result of the accident and that there is a route to managing the pain she is still experiencing. We wish her well in her recovery.