§ GUIDE · FRACTURES

The X-ray was normal.
The bone was not.

Fractures are the injury people most often ask us about, and they are the hardest to find in the law reports, because most of these claims settle long before a judge sees them. The six judgments here are the exceptions, and they show the three ways a fracture claim actually arises: the break nobody saw, the break judged wrongly, and the break treated too slowly.

Judgments read

6

Claimant succeeded

4 of 6

Largest sum stated

£4.68 million

Most common site

Wrist and ankle

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§ BEFORE YOU GO FURTHER

For a fracture claim to get anywhere, these things usually need to be true

  • A fracture was missed on an X-ray or examination, judged stable when it was not, or left untreated while it got worse.
  • Or a known fracture was operated on or immobilised in a way that caused avoidable harm.
  • You are worse off than you would have been with the right treatment: more surgery, a deformity, lasting pain or loss of function.
  • It happened within the last three years, or you only recently found out.

A fracture that heals badly is not automatically a claim, because some do even with perfect care. What matters is whether the care fell below standard and changed the outcome.

§ 01

The fracture nobody saw

Arkless v Betsi Cadwaladr is the model. A woman hurt her wrist playing football and was seen in A&E, where the doctor did not carry out all three standard clinical tests for a scaphoid fracture. The fracture went undiagnosed, she later needed a bone graft and further surgery, and the court found the examination fell below a reasonable standard. Damages had been agreed at £39,000.

Note what decided it. The X-ray itself was not criticised. The failure was the examination, because a scaphoid fracture often does not show on an early film and the clinical tests are what catch it. If you were told your X-ray was clear and the pain never settled, that is the pattern to look at.

Demery v Cardiff and Vale is the related trap: an X-ray showed a fibula fracture, but the ruptured ankle ligaments alongside it went undiagnosed for a week. The Court of Appeal held the trial judgment was flawed and sent the case back. One visible fracture does not end the assessment.

§ 02

The fracture judged wrongly

Sumner v Royal Surrey is the most serious kind. A 68-year-old fell downstairs and broke her neck; the fracture was wrongly judged stable, so she was got up and moving before surgery. The court found her permanent paralysis was caused by the failure to stabilise the spine in time.

Dee v Welsh Ambulance Services covers the same territory earlier in the chain, where an ambulance crew and an emergency department were alleged to have failed to recognise and immobilise a spinal injury. The evidence was strong enough for the court to order an interim payment of over £109,000 before trial.

If a spinal fracture could be unstable, imaging and stabilisation should not wait. Being mobilised before that question is answered is the allegation to look for.

§ 03

The fracture treated too late

Riley v Salford Royal is the largest award in this group. A 20-year-old motorcyclist with leg fractures developed compartment syndrome, which the trust admitted it treated too late, and his leg was amputated below the knee. Damages were £4,676,442.

Compartment syndrome is the emergency that turns a survivable fracture into an amputation, and pain out of proportion to the injury is its warning sign. Long v Western Sussex shows the limit: a man discharged after femoral fracture surgery without arrangements to repeat his blood tests developed a deep infection, and although the court found breaches, there was no evidence they made his condition materially worse, so the claim failed.

§ 04

Why so few of these reach court

When we searched the published judgments for missed hip fractures, missed fractures in children, casts applied without an X-ray and malunion, we found almost nothing. That is not because they do not happen. It is because fracture claims are usually worth less than the cost of fighting them, so they settle.

The practical consequence is that you should not read a shortage of famous cases as a sign your claim is weak. The evidence that matters is your own: the X-ray and the radiologist's report, the A&E notes of what was examined, and the record of what you were told to do afterwards.

§ THE JUDGMENTS BEHIND THIS GUIDE

The six judgments behind this guide.

Every one a published decision of the courts of England and Wales, linked to its source.

Claimant succeeded£39,000

Arkless v Betsi Cadwaladr University Local Health Board

[2016] EWHC 330 (QB)·2016·Liability decided at trial

A woman hurt her wrist playing football and was seen at Ysbyty Gwynedd A&E in April 2009, where the doctor did not properly carry out all three standard clinical tests for a scaphoid fracture. The fracture went undiagnosed and she later needed a bone graft and further surgery; the court found the examination fell below a reasonable standard.

A&E doctors are expected to perform and record all the recognised tests for a scaphoid fracture when a wrist injury is suspected. Skipping part of the examination can amount to negligence even if the X-ray itself is not at fault.

Mixed outcome

Demery v Cardiff and Vale NHS Trust

[2006] EWCA Civ 1131·2006·Appeal decision

A woman who hurt her ankle ice skating attended University Hospital Cardiff A&E in May 2001, where an X-ray showed a fibula fracture but associated ligament ruptures went undiagnosed for a week. The trial judge dismissed her claim, but the Court of Appeal found the judgment flawed and sent the case back for a fresh trial.

An X-ray showing one fracture does not end the assessment; associated ligament injuries visible from the alignment need to be considered. A flawed first-instance judgment can be reopened on appeal.

Claimant succeeded

Sumner v Royal Surrey County Hospital NHS Foundation Trust & Anor

[2015] EWHC 293 (QB)·2015·Liability and damages decided at trial

A 68-year-old woman fell downstairs and broke her neck; the fracture was wrongly judged stable and she was got up and moving before surgery on 5 January 2011. Andrews J found her permanent paralysis was caused by the failure to operate and stabilise the spine by 29 December 2010.

Misjudging whether a spinal fracture is stable can turn a recoverable injury into permanent paralysis. The court decided causation by tracing when her neurology got worse relative to when she was mobilised.

Claimant succeeded£4.68M

Matthew Riley v Salford Royal NHS Foundation Trust

[2022] EWHC 2417 (KB)·2022·Damages assessed at trial

A 20-year-old motorcyclist with leg fractures developed compartment syndrome which the trust admitted it treated too late, so his right leg had to be amputated below the knee. Liability was admitted and the court assessed damages at £4,676,442 covering lifelong prosthetics, care, adapted housing and lost earnings.

Where a hospital admits that quicker treatment of compartment syndrome would have saved a limb, the case becomes about valuing lifelong needs, and prosthetics, accommodation and care can each run to six or seven figures for a young claimant.

Claim failed

Long v Western Sussex Hospitals NHS Trust

[2016] EWHC 251 (QB)·2016·Liability decided at trial

After surgery for a broken femur at St Richard's Hospital, Chichester, the patient was discharged in April 2008 without arrangements to repeat his inflammatory-marker blood tests, and a deep infection was diagnosed later. The court found this discharge and a four-day debridement delay were breaches of duty, but there was no evidence they made his condition materially worse, so the claim was dismissed.

Discharging a patient without arranging follow-up blood tests can be a breach of duty, but compensation depends on showing the delay actually worsened the outcome.

Claimant succeeded

Dee v Welsh Ambulance Services NHS Trust & Ors

[2023] EWHC 2765 (KB)·2023·Damages assessed at trial

A man who fell from a scooter in May 2019 alleged the ambulance crew and the A&E department failed to recognise and immobilise a spinal injury, manage his blood pressure or protect him from pressure sores. On an interim payment application the Master was satisfied he would succeed on the hand-function and pressure-sore injuries and ordered £109,006.96.

Where the evidence of breach and causation is strong, a court can order a substantial interim payment before trial to fund immediate needs, even though the final award remains to be decided.

Browse the whole case library →

Contains information licensed under the Open Justice - Licence v2.0. Judgments from Find Case Law, The National Archives. Summaries are ours; amounts only where printed in the judgment.

§ QUESTIONS

Common questions

My X-ray was clear but the pain never went away.

That is the scaphoid pattern in Arkless, which succeeded. Some fractures do not show on an early X-ray, which is why the clinical examination and a follow-up film matter. Ask what tests were actually done and recorded.

They found one fracture and missed another injury.

Demery is exactly that: a fibula fracture was seen and the ligament ruptures alongside it were not. Finding one injury does not discharge the duty to consider the rest.

I was told a neck or back fracture was stable and got up.

Sumner succeeded on that. Whether a spinal fracture is stable is a question for imaging, and mobilising a patient before it is answered can be negligent.

My leg swelled and the pain was unbearable after a fracture.

That can be compartment syndrome, the emergency behind Riley, where late treatment led to amputation and damages of over £4.6 million. Pain out of proportion to the injury is the warning sign.

Why can I not find many cases like mine?

Because most fracture claims settle rather than going to judgment, so they never get published. That says nothing about whether your claim is good. Your own records are the evidence that counts.

§ MORE GUIDES

Plain answers to the other questions people ask.

Sent home from A&E →

A&E discharge claims: the duty that starts at the reception desk, missed warning signs, and the causation hurdle that decides most cases. Real judgments.

Limb ischaemia claims →

Eight published judgments where poor circulation to a limb was missed or treated late and the limb was lost or damaged. Five succeeded, one at £4.68 million.

The evidence that decides →

Eleven judgments showing what wins and loses these cases: the notes, the charts, the missing letter and the expert. Read this before you ask for your records.

Payout examples →

UK medical negligence payout examples by claim type, typical compensation ranges, and what decides the amount. Then check your own claim free.

Fatal negligence payouts →

What compensation after a death caused by medical negligence can include: the bereavement award, dependency, funeral costs and the estate's claim.

NHS payout data →

Official NHS Resolution figures, band by band, for 2024/25.

This guide is general information about the law in England and Wales, not legal advice about your case. ClaimGavel is run by Costart Projects Ltd on behalf of Tomlin & Partners, a specialist medical negligence firm regulated by the SRA. The free assessment on this page is an AI overview to show you roughly where you stand; a solicitor confirms the position in a free, no-obligation conversation.