Featured below is a recent case which was settled on behalf of a child "R" by Pannone. The case is not a typical DDH case, but we have decided to include this case study to highlight that despite a number of "Red Flags" and concerns raised by various health care professionals, R's DDH was not diagnosed until she was 3 years of age. The injuries in R's case were severe and it should be noted that the high amount damages received in this matter reflected the severity of R's injuries and the fact that she will require a large number of operations in the future, which in turn impacts of the amount of support she will need in the future. Thankfully most other DDH cases do not end up with injuries as severe as R and consequently their settlement value is much lower
RH (By her Mother and Litigation Friend, JH) –v- (1) Central Manchester Primary Care Trust (2) Central Manchester & Manchester Children’s University Hospitals NHS Trust.
R was born at Wythenshawe Hospital in 1997. At birth her hips were tested and no abnormality was found. R had other medical conditions and therefore was under the care of a Paediatric Endocrinologist at St Mary’s Hospital, a Paediatrician, her GP and a Health Visitor.
At 8 months of age, R was seen by a GP at the request of a Health Visitor who was concerned that she was not crawling. The GP checked both hips and noted that they were normal.
In February 1998, R was seen by a Community Child Health Specialist who was concerned that R had asymmetrical thigh creases and a restriction on abduction of 50 degrees. The Community Child Health Specialist wrote to R’s Health Visitor detailing the same and he confirmed that he would write to R’s Paediatric Endocrinologist and her Community Paediatricians about his concerns regarding the tightness of R’s hips.
In April 1998, R was seen by the Community Paediatrician who did not examine her hips and made no reference to the earlier concerns raised by the Community Health Specialist. On 6 May 1998, R was seen by a Community Physiotherapist who also expressed concerns about R’s mobility and her asymmetrical thigh creases and she wrote again to the Community Paediatrician expressing her concerns. On 18 May 1999, the Community Paediatrician wrote to the Paediatric Endocrinologist asking him to arrange a hip x-ray. No hip x-ray was arranged. On 29 May 1998 R was seen by the Paediatric Endocrinologist and her hips were not examined and no x-rays were performed.
On 1 February 1999, the Physiotherapist wrote to the Community Paediatrician stating that since no action had been taken regarding R’s hips she had assumed all was ok. On the 2 February 1999, R was seen again by the Community Paediatrician. No examination took place regarding R’s hips and there was no mention in the notes regarding the need for an x-ray or any follow up regarding the previous request for an x-ray.
Eventually, in December 1999, the Community Paediatrician saw R and noted her waddling gait and that her right leg was turning out. She arranged x-rays.
In January 2000, x-rays showed a severe bilateral congenital dislocation of hips to such a severity that both of R’s femurs had migrated and were articulating with the under side of her ileum.
Despite the numerous red flags that had been raised by the various Clinicians/Practitioners caring for R, her congenital hip dysplasia was not diagnosed until she was 3 years old.
It can be noted that the medical staff failed to arrange x-rays, despite concerns about her condition expressed by the Health Visitor, Community Child Health Specialist and Physiotherapist.
R underwent open reduction surgery to both hips.
The claim was investigated and the medical experts agreed that R’s condition should have been diagnosed when she was approximately 13 months of age. The experts agreed that she would not have avoided her open reduction surgery but she would have had a satisfactory outcome until she was aged 55 when she would require bilateral hip replacement.
As a result of the negligence her condition was much worse and the treatment was much more extensive. The medical experts concluded that R will need a right hip replacement when she is 25 years old and revision surgery at approximately 35 years old. When she is 45 years old, R will need a right girdlestones arthroplasty (removing the components of the joint replacement) after which she will be a permanent wheelchair user. She will also require a left hip replacement when she is approximately 40 years of age and revisions thereafter.
R was awarded £1.8 million in damages. £115,000 was in respect of R’s injury, in terms of her pain, suffering and loss of amenity due to the delay in diagnosing her congenital hip dysplasia to reflect her past pain and suffering and her future pain and suffering, particularly in view of the number of surgical procedures she will need to undergo. The remainder was in respect of her past care and assistance, future care and assistance, any aids and equipment R will require in order to maximise her independent living skills, any occupation therapy, physiotherapy, cost of future surgery, future transport costs and future accommodation costs.