Poor surgical repair of a fractured jaw

In 2003 Mr Gazzard’s 20 year old client was thrown off her horse and admitted to the defendant hospital under the care of an Oral Surgeon.  A fracture of the left body of the mandible in the pre-molar region was diagnosed.  As a result she underwent surgery in the form of an open reduction and internal fixation (ORIF) of the fracture.  Two “bridle wires” were placed round the necks of the teeth adjacent to the fracture and a single four hole “Wurzburg” plate was placed on the lower border of the mandible with two screws either side of the fracture line.  A post-operative x-ray was taken and reported as showing a satisfactory reduction of the fracture.

Three months later the client was discharged from out patients on the basis that her fracture “appeared stable”.  Despite attending the oral surgery department a number of times over the next 18 months and having x-rays taken twice, one of which demonstrated a widening at the site of the fracture, no further action was taken by the hospital.  Fortunately, however, in November 2010 the client was referred by her Dentist to a private Oral Surgeon and received treatment for the non-union of her mandibular fracture and early onset of osteomyelitis.  Indeed, within a matter of weeks she underwent surgery under general anaesthetic and two of the original screws holding the “Wurzburg” plate were found to be loose.

After removing one of the client’s teeth and the inflammatory and infected tissues the fracture was again reduced and fixed with two bone plates and screws.  Despite this repair the client was left with some “hypoaesthesia” (loss of sensation) on the left side of her lower lip and chin area.  Expert advice from a Consultant Oral and Maxillofacial Surgeon confirmed that a single four hole plate would not be expected to adequately stabilise a fracture of the body of the mandible and that two plates should have been used.  Breach of duty was admitted by the defendant hospital and the client was paid compensation of £40,000.00 for her pain and suffering and cost of treatment.