Failure to remove guidewire during surgery

In 2015, Mr G fell from a third storey balcony.  An ambulance was called and he was taken to hospital. He was diagnosed with nasal bone fractures, fractured right humerus, TP fracture of his lumbar spine at L1-L5, fractured pelvis and comminated fracture of his proximal femur. He also had facial injuries and broken toes on his right foot.

The Claimant had significant fixation and nailing surgery. – The main concern for this claim is in relation to this surgery.

The consent form notes that Mr G was intubated and ventilated at the time of the consent process.  It is noted that the surgery could not wait until he regained his capacity as it was an unstable and open fracture which required early fixation and washout.

After surgery, Mr G was in severe pain. He remained in hospital for approximately 2 months before transferring to a different hospital.

On review, it was noted that Mr G was fairly mobile. His wounds were well healed but he was in a great deal of discomfort.  X-rays revealed that the guidewire from the screw was left in situ.  This was palpable under the skin.  The pelvic fix looked solid on the x-ray and the right hemi-pelvis had some vertical displacement.

It was noted that this was a never event.

Mr G underwent revision surgery. During this surgery, which was predominantly to remove the femoral nail, the guidewire was also removed.

Expert evidence was obtained, as while the retention of the guidewire was a never event, it was considered that his treatment as a whole ought to be considered.  Mr G was left with a limp and leg length discrepancy and the concern was that this would have been avoided either but for the retention of the guidewire or that this would identify some additional allegations of breach.

Our expert was not critical of the standard of surgery and the decision to proceed with internal fixation.  While the surgical entry point was uncommon it was not negligent given the placing of his fractures.

The expert was critical of the retention of the guidewire and the failure to diagnose the same in the immediate post-operative period by x-ray.

But for the negligence, Mr G would either have avoided the retained guidewire or it would have been removed with a stab incision shortly after surgery. Our expert confirmed that this had not caused any additional infection and that Mr G would always have required the additional surgery to remove the pins.

It was noted that there was a failure to diagnose fractures of Mr G’s toes but in the circumstances, given the immediate need for life-saving surgery and extensive distracting injuries the presence of minor metatarsal fractures was not of any significance and can often be missed in polytrauma patients.  To fail to diagnose the fractures was not negligent in view of the other substantial injuries he had sustained.

The expert confirmed the retention of the guidewire had no significant impact on the pain Mr G was in. The extreme pain he was in, more likely resulted from the fact he had a large horizontal rod fixed with pins in his pelvis, and not from the retention of the guidewire. He confirmed it had not caused any infection and could not have contributed to his leg length discrepancy. All his ongoing issues were related to the initial fall and non-negligent injury and not the guidewire.

A Letter of Claim was sent to the Defendant on the basis that this was a never event and he would have avoided the additional small stab incision.  A Part 36 offer was made and accepted, bringing the claim to a swift conclusion.