Malpractice Litigation Following Traumatic Fracture

Abstract

Background: Poor clinical outcomes and adverse events following orthopaedic trauma are common, which may lead to litigation. To our knowledge, factors associated with litigation following fracture care have not previously been evaluated. Methods: A retrospective review of fracture-related malpractice lawsuits from 1988 to 2015 was completed utilizing VerdictSearch (ALM Media Properties), a medicolegal database. Defendant and plaintiff characteristics along with fracture type, allegations, litigation outcomes, and the association of case characteristics with outcomes were analyzed. Results: A total of 561 cases were evaluated; 360 cases were excluded, resulting in a total of 201 cases that were analyzed in detail. The mean age of the plaintiff was 43.1 years (standard deviation [SD],19.4 years). Twenty-four fracture types were represented among the analyzed cases. The most common fractures were of the radius (44), the femur (32), the tibia (30), the ulna (29), the humerus (26), the spine (24), the hip (17), and the fibula (15). Overall, 129 (64.2%) cases resulted in a defense verdict, 41 (20.4%) cases resulted in a plaintiff verdict, and 31 (15.4%) cases resulted in a settlement. For plaintiff verdicts, the mean indemnity payment was $3,778,657 (median, $753,057; range, $89,943 to $27,926,311). For settlements, the mean indemnity payment was $1,097,439 (median, $547,935; range, $103,541 to $9,445,113). The mean indemnity for plaintiff verdicts was significantly greater than the mean indemnity for settlements (p = 0.03). The presence of a neurological deficit was associated with a significantly greater likelihood of a favorable outcome for the plaintiff (52.8% for plaintiffs with neurological deficit versus 32.1% for plaintiffs without neurological deficit; p = 0.019). Conclusions: This study examined malpractice litigation following traumatic orthopaedic injuries. In cases with decisions for the plaintiff, indemnity payments were on average more than $2.5 million larger than payments for settlements. In fracture cases with neurological deficit, malpractice cases were more likely to result in a favorable outcome for the plaintiff.

Characteristics of the medical malpractice cases against orthopedists in China between 2016 and 2017

“…Our results were similar to those of many other studies. A retrospective review of fracture-related malpractice lawsuits from 1988 to 2015 in America showed that the mean age of the plaintiff was 48.5±15.2 years and the most commonly involved anatomical sites were the spine and femur [ 9 ]. Klimo et al [ 10 ] reported that the lumbar spine was the most common anatomic area involved in orthopedic medical malpractice cases.…”

Reporting errors in plain radiographs for lower limb trauma—a systematic review and meta-analysis

“…It is difficult to quantify the rate at which healthcare systems are justified in accepting the failure to detect findings. Certainly, false negatives are likely to represent the most deleterious of these errors; borne-out by the evidence on litigation for missed fractures both in the UK [ 6 , 22 ] and abroad [ 23 , 24 ].…”

Claims in orthopedic foot/ankle surgery, how can they help to improve quality of care? A retrospective claim analysis

“…They found that males and elderly patients were significantly less likely to file a claim, whereas increased comorbidity was positively associated with a claim [ 21 ]. However, a majority of male plaintiffs has also been described in a study looking at litigation after traumatic fractures [ 22 ]. Although we had no information about comorbidities, the claims in our cohort were mostly filed by young, female patients.…”

“…Despite the limitations, we feel that this study provides valuable information for the orthopedic/ trauma surgical community. Although claims have been previously studied in orthopedic fracture surgery, this study represents the largest cohort that focuses on foot/ankle surgery [ 22 , 35 ]. Given the high complication rate in this area of orthopedic surgery, it is important to identify pitfalls in (operative) care and communication, not only to prevent malpractice claims, but to improve the quality of care.…”