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Case study 39 - minor injury

Overview

This case study explores a dispute about whether a small styloid fracture to the wrist is a minor injury under Schedule 2 section 2(e) of the Motor Accident Injuries Act 2017 (the Act).

Introduction

The claimant’s motor vehicle was hit from the left by a vehicle not giving way. The claimant was wearing a seatbelt. They were assisted out of the vehicle by bystanders. An ambulance attended the accident, however the claimant was not taken to hospital. The claimant was picked up from the scene of the accident and taken home, their vehicle was subsequently “written off”.

The claimant attended their general practitioner over the coming weeks. Due to pain increasing over time which became unbearable, the claimant reported a right wrist injury 3 weeks post-accident. X-rays indicated a “slight fracture”. The claimant was prescribed analgesia and referred for a further x-ray and ultrasound, which took place 4 weeks later. The results of these scans found no changes.

The Assessment

There is a dispute about whether the injury is a minor injury under Schedule 2 section 2(e) of the Motor Accident Injuries Act 2017 (the Act).

Clinical Examination

  • On examination, the wrist was tender over the right ulnar styloid and over the radial aspect
  • Tinel’s sign over the median and ulnar nerves at the wrist and elbows were negative
  • Froment’s test for motor function of the ulnar nerve in the hands was unremarkable
  • Reflexes at the biceps, triceps, and supinator jerks were equal and within normal limits
  • No muscle wasting or reduced range of motion was observed following measurement

Review of Documentation

The clinical notes of the GP commence 2 days following the accident, noting the accident and reporting ‘dizziness, pain in the back of the head, sore neck, sore across chest, and pain in the back of the head’.

An x-ray was completed 1 month post-accident on the right wrist.

3 months post-accident the GP notes indicate accident ‘whiplash plus right wrist injury, refer physio’. This was the first indication of the right wrist in the notes/formal documentation.

Diagnosis

The imaging was present at the assessment, the assessor noted the imaging as “not convincing for a fracture. I could not detect any fracture.” There was a note by the assessor that standard practice for radiographers is to report any possible abnormality and that this could be a possible finding, however, is not absolute evidence of a pathological finding.

A fracture, even if as small and displaced as this one is reported to be would be painful at the time of the accident and therefore this injury is medically implausible.

Thus, reviewing the totality of the evidence and the outcome of the clinical examination it is indicative that there has not been a fracture or a significant cartilage injury.

Minor Injury

Section 1.6(2) of the Act

A soft tissue injury is (subject to this section) an injury to tissue that connects, supports or surrounds, other structures or organs of the body (such as muscles, tendons, ligaments, menisci, cartilage, fascia fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage.

Schedule 1 [2] clause 4 of the Motor Accident Injuries Regulation 2017:

  • 1) An injury to a spinal nerve root that manifests in neurological signs (other than radiculopathy) is included as a soft tissue injury for the purposes of the Act.

The following injury is a minor injury

  • Right Wrist- fracture