The High Court dismissed Nancy Scott’s negligence action against orthopaedic surgeon Andrew Macey and the Health Service Executive over a femur fracture sustained during a hip replacement at Sligo General Hospital in March 2003. Mr Justice O’Neill found that Macey had not fallen below the expected standard of care when he used a surgical profiler to tap a cement restrictor into position.
Scott had undergone an earlier operation after a fall in her back garden in October 2002 caused a fracture to her left femur. The fracture failed to unite after avascular necrosis developed, and a total hip replacement was performed on 19 March 2003. The judgment describes the earlier operation as appropriate and says Scott accepted that it had been carried out professionally.
During the replacement procedure, Macey used an “A” profiler to tap a Hardinge Plug, which restricts the flow of cement within the femur. He had first used an introducer to place the plug, but removed it before the plug reached its intended final depth. He said the curved shape of the femur made the straight introducer difficult to manoeuvre and risked pushing the plug off-centre.
Macey felt the instrument “give way” as he tapped. He stopped and carried out checks, but concluded there was no fracture and continued the operation. A postoperative X-ray showed a fracture on the lateral side of the femur, near the tip of the prosthesis. Scott was unwell after the epidural anaesthetic, and Macey did not return her to theatre that night.
The judge concluded that the initial opening of the fracture occurred while the profiler was being tapped down. He accepted that the bone was in poor condition and that accumulated stresses were likely the primary contributing factor, with the tapping force acting as the tipping point. The fracture may have been extended when cement and the prosthesis were later inserted.
The claim focused chiefly on whether using the profiler was negligent because its tapered end could deflect and cause injury. The judge found that using broaches or trial prostheses to position a Hardinge Plug was common practice. Given the soft bone around the plug, the open canal below it and the gentle force used, he considered the risk of this type of injury remote when assessed in advance. He found that the profiler offered an apparent advantage in reaching the centre of the plug and moving it downwards.
The court also rejected a separate allegation that Macey should have arranged an X-ray during the operation after suspecting a fracture. It found that the clinical checks performed made the decision not to take an X-ray consistent with acceptable practice, considering the added time and infection risk. The court found no negligence and dismissed Scott’s action. The judgment does not state a damages award or other order.