If a fracture was missed on your X-ray in A&E or another healthcare setting in the UK, and the delay caused you additional harm, you may be able to claim compensation. Missed fractures are one of the most common types of clinical negligence in emergency departments. The claim is for the extra harm caused by the delayed diagnosis — such as non-union, malunion or avascular necrosis — not for the original injury. You normally have three years to bring a claim.
Fractures can be subtle on X-ray, and emergency departments work under intense time pressure. But when a doctor fails to spot a clearly visible fracture, fails to order an X-ray when clinical signs demand one, or fails to arrange follow-up for inconclusive imaging, the consequences can be severe: bones that fail to heal, bones that heal crooked, chronic pain, and operations that would have been avoidable. This guide explains how missed fracture claims work in the UK. We are an independent information service, not a law firm.
What is a missed fracture?
A missed fracture claim arises when a healthcare professional fails to diagnose a fracture that should have been identified with reasonable care. The error may involve:
- Misreading the X-ray. The fracture line is visible but the clinician fails to identify it.
- Failing to order imaging. The clinical picture — mechanism of injury, pain pattern, swelling, inability to weight-bear — warranted an X-ray but none was taken.
- Ordering the wrong views. Standard views may not show certain fractures; for example, a scaphoid fracture often requires dedicated views or MRI.
- Failing to follow up. When initial imaging is inconclusive, guidelines advise treating as a presumed fracture and arranging repeat imaging. Failing to do so can be negligent.
Commonly missed fractures
| Fracture | Why it is missed | Consequence of delay |
|---|---|---|
| Scaphoid (wrist) | Often invisible on initial X-ray; requires dedicated views or MRI | Avascular necrosis, non-union, wrist arthritis |
| Radial head (elbow) | Subtle cortical irregularity; fat-pad sign may be overlooked | Stiffness, reduced range of motion |
| Lateral malleolus (ankle) | Undisplaced fractures can mimic sprains | Malunion, chronic instability, arthritis |
| Metatarsal stress fracture | May not appear on X-ray for 2–3 weeks | Complete fracture, prolonged recovery |
| Spinal compression fracture | Subtle height loss on lateral view | Progressive kyphosis, chronic pain, neurological deficit |
| Femoral neck (hip) | Impacted or undisplaced fractures appear normal on X-ray | Displacement, need for hip replacement |
Consequences of delayed diagnosis
- Non-union — the bone fails to heal because it was not immobilised; may require bone-graft surgery.
- Malunion — it heals in the wrong position, causing deformity; corrective osteotomy may be needed.
- Avascular necrosis — disrupted blood supply causes the bone to die. A particular risk with scaphoid and femoral neck fractures.
- Chronic pain and post-traumatic arthritis.
- Additional surgery that would not have been necessary with timely treatment.
Proving negligence
You must show (1) that a reasonably competent clinician would have identified the fracture or ordered appropriate imaging (Bolam/Bolitho test), and (2) that the delay caused additional harm. An independent expert — a consultant radiologist or orthopaedic surgeon — will review the original images and clinical notes. Many NHS trusts operate a “hot-reporting” system where radiologists review A&E X-rays after the patient has left, and a recall mechanism should catch missed findings. If both the A&E clinician and the reporting radiologist missed the fracture, both may have been negligent.
Compensation
You claim for the additional harm caused by the delay, not the original fracture. General damages are assessed under the Judicial College Guidelines (17th edition, 2024) for the specific consequence — for example, wrist arthritis from an untreated scaphoid, or the need for hip replacement due to a displaced femoral neck fracture. Special damages cover additional time off work, extra treatment costs, physiotherapy, travel and care. Where the consequences are severe, awards can be substantial.
Time limits
You generally have three years from the date of the missed diagnosis, or from the date of knowledge (Limitation Act 1980, ss.11 and 14). Because missed fractures are often discovered only later when symptoms persist, the date of knowledge is frequently later than the original A&E visit. For children, three years from age 18. The court has a discretion under s.33 to extend time.
Getting help
We are not a law firm. For a clinical negligence solicitor, use the Law Society “Find a Solicitor” service or contact AvMA. Most claims are funded on a no-win-no-fee basis.
Frequently asked questions
What is a missed fracture claim?
It is a clinical negligence claim arising when a doctor fails to identify a fracture on an X-ray or fails to order imaging when clinically indicated. The claim is for the additional harm caused by the delay in diagnosis and treatment, not for the original injury.
Which fractures are most commonly missed?
Scaphoid wrist fractures are among the most frequently missed because they can be invisible on initial X-rays. Other commonly missed fractures include stress fractures of the foot, undisplaced ankle fractures, radial head fractures of the elbow, and subtle spinal compression fractures.
What harm does a missed fracture cause?
Delayed diagnosis can lead to non-union, malunion, avascular necrosis, chronic pain, arthritis, and the need for additional surgery that would not have been required with prompt treatment.
How do I prove negligence?
You need to show that a reasonably competent doctor would have identified the fracture or ordered further imaging. An independent expert will review the original X-rays and clinical notes. You must also show the delay caused you additional harm beyond the original injury.
How long do I have to claim?
Generally three years from the missed diagnosis or three years from the date you first knew the fracture had been missed. For children, three years from age 18. For those lacking mental capacity, no deadline while the disability persists.
What compensation could I receive?
Compensation covers the additional pain and suffering caused by the delay, any additional surgery, extended time off work, physiotherapy and other losses. A missed scaphoid fracture leading to avascular necrosis attracts significantly more than a missed toe fracture with no lasting effect.
What if the X-ray was reported by a radiologist?
If the radiologist also missed the fracture, the claim may be against both the treating clinician and the radiologist. In NHS claims, the trust is vicariously liable for both. A recall system should catch missed findings from formal reporting.
Can I claim if I went to a walk-in centre?
Yes, the same principles apply. Whether you attended A&E, a walk-in centre, an urgent treatment centre or a minor injuries unit, the clinician owed you the same duty of care when interpreting imaging and making a diagnosis.
Get help from official, free sources
- Solicitors Regulation Authority (SRA) — check a solicitor is regulated
- The Law Society — Find a Solicitor — clinical negligence accredited specialists
- Citizens Advice — free, impartial guidance on your rights
- Action against Medical Accidents (AvMA) — charity supporting victims of medical harm
Related guides: medical negligence claims, broken bone claims, ankle injury claims, wrist injury claims, how compensation works, and no win, no fee explained.