Stockport NHS Foundation Trust

3. Mrs T complains the Trust missed identifying fractures in December 2024 and January 2025 after a fall and an MRI scan was not completed on both occasions.

4. Mrs T says only after seeking private health advice were five fractures found. This meant the Trust’s physiotherapy and pain management advice was incorrect. As a result, Mrs T experienced extended pain, poor mobility and expenses for completing private imaging.

5. Mrs T wants service improvements and financial compensation of £10,064. This is for private imaging costs of £2,564 and £7,500 for the impact and stress caused.

6. Mrs T went to the Trust in early December 2024 after falling on her right side at home. The Trust arranged for X-rays of Mrs T’s lower back and pelvis and a computerised tomography (CT) scan of her head.

7. The Trust radiographer reported the findings from Mrs T’s X-ray of her pelvis, hip, and lower back. Mrs T’s pelvis bones were osteopenic (low in bone density), but no fractures were found.

8. The Trust also noted it compared this result with a previous report from August 2023 which again showed Mrs T had low bone density. A malalignment and narrowing of her discs which was a longstanding condition and no bone, joint abnormalities or fracture was found.

9. The Trust sent Mrs T home with pain relief on the same day.

10. Mrs T went to A&E in late January 2025 for pain to her left lower back moving to her left knee since her fall in December 2024. The Trust doctor noted that Mrs T had begun private physiotherapy and advised her to continue with this as much as possible.

11. Mrs T had a private CT scan in mid- February because of pain she experienced since falling. The scans showed Mrs T had some healing fractures to her pubic rami (front and bottom of each side of the pelvis connecting to the hip) and fractures to discs in her back.

15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

16. Mr O represents his mother in the complaint. He complains the Trust missed finding fractures that happened from her fall, which meant its pain management and advice was wrong. Mr O says his mother experienced prolonged pain, poor mobility and expenses for completing private imaging.

17. The Trust said it gave Mrs T appropriate imaging, pain relief and advice when she attended the hospital.

18. NG41, section 1.5.9 tells clinicians, ‘Perform an x-ray as the first line investigation for people with thoracic and lumbosacral column injury without neurological signs and symptoms.’

19. HECTOR guidance advises, ‘if patients present following simple falls with thoracic or lumbar tenderness they can be imaged primarily by performing plan x-rays AP/Lateral of the spine. If any abnormality is detected then further imaging with either CT or MRI should be carried out.’

20. The records show Mrs T went to the Trust in early December 2024 due to falling on her right shoulder, elbow and hip. Mrs T also told the Trust she banged her head and had pain in her lower back and right side of her groin.

21. The Trust noted Mrs T’s past medical history which included osteoporosis which makes bones, thin, porous and fragile, accompanied by previous 11th vertebrae, lower thoracic spine and second lumbar vertebrae in the upper middle of the lower back fragility (underlying weak bones) fractures. The Trust also noted Mrs T’s fourth vertebrae lower back and fifth lower vertebrae above the tailbone fragility fractures.

22. A doctor examined Mrs T’s chest, heart, stomach and breathing and noted them as normal. The Trust also saw Mrs T had no signs of a head injury, no spine tenderness but some pain in her groin and was unable to raise her leg straight which was documented to be a sign of a neck of femur (joint attaching the hip to the thigh bone) fracture.

23. The Trust arranged for Mrs T to have X-rays of her spine, neck of femur, trunk (upper body to the pelvis and spine), lower right limb and a CT scan of her head and neck. This was in line with NG41 section 1.5.9 and HECTOR guidelines as the Trust completed X- ray and CT imaging after Mrs T’s fall.

24. The Trust reported on the findings from Mrs T’s X-rays and head CT scan finding no new injuries to her pelvis and hips. The Trust found old fragility fractures of her T11 and L2 and spondylolisthesis (one vertebrae slipping over the other causing lower back pain and nerve compression) of Mrs T’s L4 and 5. The Trust found no bleeding from the CT taken of her head.

25. As the Trust considered Mrs T’s X-rays and scan were normal finding no new fractures and she was able to walk unaided it discharged her with pain relief and safety netting to return or to see her GP if her pain was not controlled.

26. The records show Mrs T returned to the Trust in late January 2025 nearly two months after her initial fall with pain in her lower back which moved into her left hip, causing her to struggle walking.

27. The Trust recorded her observations such as temperature, pulse, oxygen level and heart rate. The Trust noted these were normal apart from a slightly raised heart rate.

28. The Trust examined Mrs T’s back, hip and groin noting there was no tenderness but some muscle soreness. Mrs T had no knee swelling and had full movement apart from some pain when raising her leg.

29. The Trust spoke with Mrs T and her son who said they had chosen to get private physiotherapy after her fall. The Trust gave Mrs T a prescription for amitriptyline (nerve pain medication) to help with the muscular and spasm pain she was experiencing. The Trust also made a referral for Mrs T to see an outpatient physiotherapist and recommended she be referred to a pain clinic if her symptoms were not controlled.

30. Mrs T told us the Trust should have completed an MRI during both visits.

31. CG124 guidelines says, ‘offer an MRI if hip fracture is suspected despite negative X-rays of the hip of an adequate standard’. HECTOR guidelines tell clinicians, ‘If any abnormality is detected then further imaging with either CT or MRI should be carried out.’

32. The Trust did not find any new fractures after Mrs T’s fall in December 2024, and when she attended the Trust again in January 2025 the Trust found Mrs T had no additional injury to suggest an MRI scan was necessary.

33. The Trust acted in line with HECTOR guidelines by not giving Mrs T any imaging because the first incident occurred from a simple fall and on the second visit no injury had occurred.

34. Our adviser told us the pain Mrs T experienced when she presented to the Trust in January appeared arthritic in nature with an element of her nerves being pinched and agreed with the actions taken.

35. Our adviser also told us fractures around the base of the spine are treated conservatively with pain killers and nerve pain medication, and also with as much movement that a patient can tolerate and physiotherapy.

36. Based on the evidence we have seen, the Trust acted in line with appropriate guidelines completing appropriate investigations and imaging. There was no requirement for an MRI scan because it had no suspicions from its investigations that a neck of femur fracture or any injuries were there to support the scan being needed.

37. We understand and acknowledge the distress Mrs T and her family feel about their concerns over the care she received. We hope our explanation goes some way to explaining how the Trust acted in line with NICE and HECTOR imaging and care guidelines.

1. We have carefully considered Mrs T’s complaint about Stockport NHS Foundation Trust (the Trust). We are sorry to hear about Mrs T’s experience with the recognising of fractures and management of her care. We understand how distressing it is to feel you are not getting the care you need.

2. Having investigated her complaint, the evidence suggests the Trust completed imaging and treated Mrs T in line with relevant guidance. We hope she is reassured by what we have seen.