An opinion drawn from the trials the court will be referred to
Including the two questions these claims most often turn on
Professor Warwick is a co-author of the SWIFFT trial, the randomised controlled trial comparing surgery against cast immobilisation for bicortical fractures of the scaphoid waist, published in The Lancet in 2020. Where a claim turns on whether operative or non-operative management was reasonable, that is the evidence base the court is likely to be referred to.
He is also first author of Does a distal radial fracture lead to osteoarthritis? Re-examining the evidence for early treatment, published in the Journal of Hand Surgery (European Volume) in 2025. That paper addresses the causation question that arises in a large proportion of wrist claims: whether the arthritis now complained of is genuinely attributable to the index fracture.
He remains in full-time clinical practice, so an opinion on what a reasonable clinician would have done is grounded in current practice rather than retrospective review alone.
What the report can address
Three questions are addressed in every report: whether the treatment chosen fell within the range a reasonable hand surgeon would have offered, whether a complication reflects a recognised risk or a departure from acceptable practice, and what is attributable to the natural history of the condition rather than to the treatment given. Beyond those, the report addresses the issues pleaded, and states a range of opinion where one genuinely exists.
Missed and delayed diagnosis
Whether the initial assessment, imaging and follow-up met the standard reasonably expected, and whether a scaphoid fracture should have been identified sooner.
What difference earlier diagnosis would have made: whether non-union, avascular necrosis or later arthritis would have been avoided on the balance of probabilities.
Clinical negligence
Whether the choice between surgical fixation and cast immobilisation fell within the range a reasonable surgeon would adopt for the fracture pattern demonstrated.
Whether malunion, non-union or hardware complications reflect a recognised risk of properly performed treatment or a departure from acceptable practice.
Causation
Whether post-traumatic arthritis is genuinely attributable to the index fracture, to its management, or to pre-existing degenerative change.
Where the literature does not support a confident conclusion either way, the report says so plainly rather than overstating the position.
Condition, prognosis and quantum
Range of movement, grip strength, deformity and pain, and the effect on work, hobbies and daily activities.
The likelihood and timing of further surgery, the prospect of progressive arthritis, and reasonable costings for future treatment.
Peer-reviewed research
A selection of Professor Warwick's published work in this area, all indexed on PubMed.
How to instruct
Instructions are accepted from Claimant and Defendant solicitors, insurers and medico-legal agencies, and as Single Joint Expert. Examinations are held in Southampton, Winchester and Jersey, and the practice accepts instructions nationwide.
Separate rates apply for NHS Resolution panel solicitors. Fixed report fees and deferred payment terms are available. Professor Warwick's medico-legal work is fully indemnified by Sempris, and he is registered with the General Medical Council with entry on the Specialist Register.