Orthopaedic clinical negligence reports

Not on its own. Nerve injury, infection and implant failure can happen even when an operation is carried out with reasonable care. The expert considers whether the surgery met the standard of a reasonably competent orthopaedic surgeon, applying Bolam as refined by Bolitho, and whether the complication was recognised and treated as it should have been. The court decides whether the standard was met.

Under Montgomery, the surgeon must take reasonable care to ensure the patient is aware of any material risks of the recommended operation and of any reasonable alternatives, which can include no treatment. A risk is material if a reasonable person in the patient's position would be likely to attach significance to it, or if the surgeon knew or should reasonably have known that this patient would. In McCulloch v Forth Valley Health Board [2023] UKSC 26, the Supreme Court held that whether an alternative is reasonable is judged by the professional practice test, the same Bolam approach used for treatment.

Usually two. Breach of duty is judged by the standard of the post held by whoever missed the fracture, so the breach expert is usually in emergency medicine where a doctor missed it, a nurse practitioner expert where an emergency nurse practitioner did, or a radiologist where a radiology report is criticised. An orthopaedic surgeon then addresses causation: what treatment a correct diagnosis would have led to and whether, on the balance of probabilities, the outcome would have been better, as with a missed scaphoid fracture that goes on to non-union.

The GP and hospital records, the operation note and anaesthetic record, implant details, the consent form and any information leaflet given before surgery, and physiotherapy notes. The imaging itself should be sent, not only the radiology reports, because the expert may need to review the images directly.