The Medico-Legal Risks of Missed Paediatric Orthopaedic Injuries: A Practical Guide for Legal Professionals

Paediatric orthopaedic injuries can appear straightforward at first glance, but when growth plate involvement is missed, poorly monitored, or inadequately managed, the long-term consequences can be severe.

Growth plate injuries are among the most common fractures in children, accounting for around 15% of fractures in those under the age of 16. In many cases, these injuries heal well when identified and treated appropriately. However, when diagnosis, referral, imaging, treatment, or follow-up falls short, the effects can continue long after the initial fracture appears to have resolved.

Missed or mismanaged paediatric orthopaedic injuries can lead to growth arrest, angular deformity, leg length discrepancy, abnormal joint mechanics, early arthritis, reduced mobility, repeated surgery, psychological distress, and long-term functional impairment. For solicitors, this creates complex questions around breach of duty, causation, prognosis, quantum, and future loss.

These claims are rarely simple. A poor outcome does not automatically mean negligent care occurred, as some growth plate injuries carry an inherent risk of complications even with appropriate treatment. The key medico-legal issue is whether delayed diagnosis, inadequate monitoring, poor treatment technique, or failure to arrange specialist follow-up materially worsened the child’s outcome.

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Drawing on clinical and medico-legal insights from our webinar on paediatric orthopaedic trauma, this eBook explores the risks associated with missed growth plate injuries and the practical issues solicitors should consider when assessing potential claims.

It examines why injury location, fracture type, timing of treatment, imaging, and follow-up are critical to long-term outcome. It also highlights common red flags in the medical records, including lack of growth plate documentation, absence of Salter-Harris classification, inadequate follow-up after high-risk injuries, delayed fracture reduction, and failure to refer to a paediatric orthopaedic specialist.

The guide also addresses the evidential difficulties that often arise in these cases. Solicitors must distinguish between harm caused by the original injury and harm caused or worsened by substandard care. This often requires detailed expert evidence, careful review of imaging, and a clear understanding of how growth disturbance may develop over months or years.

For legal professionals, these issues have direct implications for case screening, expert instruction, causation analysis, valuation, rehabilitation planning, and future loss claims. Claims may be weakened or undervalued where the injury is treated as a routine childhood fracture, rather than assessed in the context of future growth, function, mobility, independence, and quality of life.

Written specifically for those working on clinical negligence and personal injury claims, this guide provides a practical framework for identifying viable paediatric orthopaedic injury claims and understanding the medico-legal risks associated with missed or poorly managed growth plate injuries.

Ultimately, the central question is not simply whether the fracture healed, but whether the child’s future growth, movement, and function were protected.

This guide was produced by INNEG and is based on key clinical insights shared during our Paediatric Orthopaedic Trauma: Missed Injuries and Medico-Legal Risks webinar, delivered by Mr Max Mifsud, Consultant Orthopaedic Surgeon.