Out of Court Settlement of Malpractice Claims Relating to the Treatment of Fractures in Children

Vinz, H; Neu, Johann

doi:10.3238/arztebl.2009.0491

Cited by 9 publications

(5 citation statements)

References 12 publications

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“…One of the most detailed reports of malpractice suits in children treated for fractures was published in 2009 by Vinz and Neu [24]. In their analysis, the authors found a total of 189 cases brought forward to the North German arbitration board during an 8-year time interval from 2000 through 2007.…”

Section: Discussionmentioning

confidence: 99%

A detailed analysis of pediatric surgical malpractice claims in Germany: what is the probability of a pediatric surgeon to be accused or convicted?

Mahler

Gianicolo

Muensterer

2021

Langenbecks Arch Surg

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Aim of the study Pediatric surgeons treat a vulnerable population in which unfavorable outcome can lead to substantial long-term costs, placing them at risk for malpractice claims. This study aims to characterize the frequency and circumstances in which malpractice claims were successfully brought against pediatric surgeons in Germany over the last 5 years. Materials and methods Anonymous data on medical treatment errors and payments were acquired from the Federal Chamber of Physicians from 2014 through 2018 and analyzed for most frequent diagnoses and circumstances that resulted in accusation or conviction. Those claims that were successfully rebutted were compared to as controls. Lifetime risk for being involved in litigation and its outcome was calculated. Results There were 129 medical malpractice claims over the 5-year observation period. Medical error was confirmed in 56 cases (43%); the rest were successfully appealed. The risk of the prototypical German pediatric surgeon to be accused was 5.24% and to be convicted 2.27% per year in practice. The most common reasons for conviction (alone or in combination) were surgical-technical errors (23%), treatment delay (21%), insufficient workup (17%), incorrect diagnosis (17%), and incomplete consent (16%).The most frequent circumstances leading to a conviction were trauma (27%), inguinal hernia (7%), circumcision (7%), testicular torsion (7%), acute abdomen (7%), and appendicitis (5%). Conclusion Over a 40-year career, pediatric surgeons in Germany face an average calculated risk of 2.1 to be accused and 0.9 to be convicted of malpractice claims. Certain circumstances pose higher risks for litigation than others. Knowledge of these patterns may help practitioners avoid medicolegal confrontation.

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Section: Discussionmentioning

confidence: 99%

A detailed analysis of pediatric surgical malpractice claims in Germany: what is the probability of a pediatric surgeon to be accused or convicted?

Mahler

Gianicolo

Muensterer

2021

Langenbecks Arch Surg

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“…In addition to strain, two stress-based criteria were also used to evaluate potential fracture (Table X). The ultimate tensile strength of pediatric bone as measured by Vinz (1969) was compared to the FE predicted maximum principal stress outcome. The ultimate flexural strength as measured by Currey and Butler (1975) was compared to the FE predicted maximum principal stress outcome.…”

Section: Validation Criteria and Evaluationmentioning

confidence: 99%

“…In summary, potential fracture was determined using either yield strain or stress-based criteria, along with element-based criteria. (Currey & Butler, 1975) Ultimate Tensile Strength 100MPa (Vinz, 1969) IV. RESULTS…”

Section: Validation Criteria and Evaluationmentioning

confidence: 99%

“…All trials exceeding the tensile yield strain criteria also exceeded the tensile strength threshold of 100MPa. Two pediatric bone studies have considered the ultimate tensile strength of the femur which ranged from 86MPa to 115MPa for children ranging from six months old to 1.5 years old (Hirsch & Evans, 1965;Vinz, 1969). The higher end of the range in the study by Hirsch was tested at a higher displacement rate of 10mm/min versus 0.5 to 1mm/min as tested by Vinz et al These displacement rates are lower than what is observed in the common household falls evaluated compared to estimated impact velocities of a minimum of 2.1m/s in the ATD falls.…”

Section: Identification Of Potential Femur Fractures In Bed Fallsmentioning

confidence: 99%

“…(Currey & Butler, 1975); 2(Hirsch & Evans, 1965); 3(Lindahl & Lindgren, 1967); 4 (Ohman et al, 2011); 5(Vinz, 1969); 6(Roberts, 1971) …”

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confidence: 99%

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Investigating the likelihood of pediatric femur fracture due to falls through finite element analysis.

McKinsey¹

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Bone fracture is the second most common injury of child abuse. Studies have generally reported that femur fractures are more likely due to abuse than accidental causes in cases where the child is non-ambulatory. They have also found that household falls are commonly offered as the cause of injury in cases of abuse. In this study, a finite element (FE) pediatric femur model will be developed and used to evaluate likelihood of fracture in common household fall scenarios (bed falls and feet first falls). This will provide greater biomechanical evidence as to the likelihood of femur fracture due to common fall scenarios which may serve to better inform clinicians when assessing compatibility between stated cause and injury when household falls are reported. The purpose of this study is to determine the likelihood of fracture of a 12-month-old child's femur due to commonly reported accidental fall scenarios using finite element analysis. Loading conditions in the FE model were derived from femur loads reported in a previously study measured using a 12-month old anthropomorphic test device (ATD) in experimentally simulated household falls. A FE femur model was derived from a CT scan performed on an 11month old child. Validation of the FE model was conducted through mechanical testing of a bone vi surrogate printed using selective laser sintering of glass-fiber reinforced nylon. The finite element model used simple support for the constraints and the loads from the ATD study were applied at the corresponding location of the load cells, which bounded the diaphysis of the femur. The FE predicted outcomes including maximum principal stress and strain values were used to evaluate the likelihood of fracture by comparing to three different thresholds: (1) tensile yield strain, (2) ultimate tensile strength, and (3) ultimate flexural strength. Fifty-percent of bed falls exceeded the yield strain and ultimate tensile strength fracture threshold whereas only two (of 12) exceeded the flexural strength fracture threshold. Different bed fall dynamics considered resulted in a significant difference in peak strains while impact surface did not. Peak strains in bed falls were associated with the peak bending moment. No feet-first falls exceeded fracture thresholds. Fall height resulted in a significant difference in peak strains while the impact surface did not. Peak strains in feet-first falls were associated with the peak bending moment or torsional loads. vii

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Verletzungen bei Kindern und Jugendlichen im Bereitschaftsdienst

Ruffing

Danko

et al. 2015

Unfallchirurg

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Knowledge of the frequency and age dynamics is essential for competent treatment of injuries in children and adolescents. Analysis of the reality of the treatment in emergency services allows a much better evaluation of the requirements with respect to this clientele. The collected data can serve as a basis for the development of major capability foci, training concepts, treatment algorithms as well as prevention measures.

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Out of Court Settlement of Malpractice Claims Relating to the Treatment of Fractures in Children

Cited by 9 publications

References 12 publications

A detailed analysis of pediatric surgical malpractice claims in Germany: what is the probability of a pediatric surgeon to be accused or convicted?

A detailed analysis of pediatric surgical malpractice claims in Germany: what is the probability of a pediatric surgeon to be accused or convicted?

Investigating the likelihood of pediatric femur fracture due to falls through finite element analysis.

Verletzungen bei Kindern und Jugendlichen im Bereitschaftsdienst

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