Delayed diagnosis of tibial plateau fracture


A missed diagnosis on X-Ray (radiograph) results in the delayed treatment of a tibial plateau fracture.  A medical negligence case requiring a Radiology expert witness and Orthopedic Surgeon medical expert witness review.



When a skeletal (x-ray, radiograph) imaging study is misread, patient care may be delayed or neglected altogether. While a RADIOLOGY medical expert witness is required to address the standard of care, issues related to causation and harm must be analyzed by an ORTHOPEDIC SURGERY medical expert witness.



A 34-year-old woman injured her knee injury and presented to an emergency department. The emergency physician examined her and ordered a radiograph. His interpretation was negative as was the interpretation of the radiologist who over-read the film on the following day. The patient was discharged with ongoing pain and persistent gait limitations. Nearly one month later it was discovered that she had suffered an unrecognized tibial plateau fracture that had become displaced. She eventually underwent surgery.



During ELITE’s complimentary case consultation, our physician-led team highlighted the need for a RADIOLOGY expert witness on standard of care and an ORTHOPEDIC SURGERY medical expert on causation. The ORTHOPEDIC medical expert’s role was to analyze the nature, extent, and prognosis of the patient’s injury and to determine how her course would have differed with earlier management. Our team further determined that the fracture was subtle and that the emergency physician would not be held liable for missing it, especially since it was also missed by the radiologist who possessed a greater degree of interpretative skill.



Within 3 days, ELITE secured a nationally recognized ORTHOPEDIC SURGERY medical expert witness from the faculty of a major East Coast medical university. The ORTHOPEDIC medical expert specialized in orthopedic trauma and routinely treated tibial plateau fractures. ELITE also retained a Clinical Professor of RADIOLOGY as an expert witness on standard of care. The RADIOLOGY medical expert witness also had staff privileges at a community hospital similar to the one visited by the patient in the case.



The RADIOLOGY expert witness testified that the fracture was visible on the original films and that it breached the standard of care to miss it. The ORTHOPEDIC SURGERY expert witness opined that had the fracture been recognized on day one, the woman would have been treated non-operatively and would have had a full recovery. In other words, the delay in diagnosis and treatment was the proximate cause of the woman’s need for surgery.


Contact ELITE today to find the right medical experts for your case.


E-CASE STUDIES are brief clinical vignettes based upon actual cases handled by ELITE. Identifying information has been redacted or altered to protect case confidentiality.

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