The litigation cost of negligent scaphoid fracture management

Harrison, W. D.; Newton, Ashley W.; Cheung, Graham

doi:10.1097/mej.0000000000000152

Cited by 27 publications

(18 citation statements)

References 7 publications

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“… 1 , 14 While several European studies have examined the frequency of orthopaedic malpractice claims in an effort to reduce litigation, little is known regarding orthopaedic malpractice claims in the United States. 12 , 16 , 18 Nevertheless, complications and malpractice claims are a reality for orthopaedic sports medicine surgeons. Indeed, complications may occur in as many as 1.3% of ACL reconstructions.…”

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confidence: 99%

Factors Associated With Physician Loss in Anterior Cruciate Ligament Reconstruction Malpractice Lawsuits

Bokshan

Ruttiman

Eltorai

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Anterior cruciate ligament (ACL) reconstruction is among the most common orthopaedic procedures, with its incidence doubling over the past decade. To date, no studies have analyzed litigation after ACL reconstruction.Purpose:To characterize the causes of malpractice litigation after ACL reconstruction.Study Design:Cross-sectional study.Methods:A retrospective review of malpractice lawsuits after ACL reconstruction was performed using VerdictSearch, a large legal claims database encompassing nearly 180,000 legal cases, from February 1988 to May 2015. Settlement rates and physician loss rates were calculated along with 95% CIs for each complication type, and analysis of variance was used to compare all indemnity payments.Results:Of a total 30 lawsuits, 5 (16.7%) settled out of court. The 3 most common complications leading to litigation were prolonged pain (n = 5, 16.7%), infection (n = 5, 16.7%), and malpositioned graft (n = 5, 16.7%). Of the 25 cases that went to court, 8 (32.0%) ended in favor of the plaintiff (physician loss). Damage to a neurovascular structure resulted in the highest indemnity payment (mean, $2,012,926 ± $1,076,530; P = .021). Lawsuits for which pain or loss of range of motion was the only complication were significantly more likely to end in a physician victory (P = .04) and lower indemnity payments ($87,500 vs $678,715, respectively). Cases that involved a surgical technical error were more likely to result in a physician loss (P = .01), with malpositioned grafts having a significantly higher loss rate than average (75% vs 32%, respectively).Conclusion:After ACL reconstruction, physicians are more likely to win malpractice suits if pain or limited range of motion is the only complaint and less likely to win if a surgical error was alleged. These findings may help to set patient expectations and provide adequate guidance during the informed consent process.

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confidence: 99%

Factors Associated With Physician Loss in Anterior Cruciate Ligament Reconstruction Malpractice Lawsuits

Bokshan

Ruttiman

Eltorai

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…The cost of missing a scaphoid fracture is not acceptable, both to the patient and the treating clinician. The mean litigation cost of a negligent scaphoid misdiagnosis in the UK is £34,450 (Harrison et al., 2014) in addition to the misery inflicted on the patient. In the absence of a single clinical test that is pathognomonic of an occult scaphoid fracture, we recommend an early MRI scan in cases selected after clinical examination.…”

Section: Discussionmentioning

confidence: 99%

Reliability of clinical tests for prediction of occult scaphoid fractures and cost benefit analysis of a dedicated scaphoid pathway

Kodumuri

McDonough

Lyle

et al. 2020

J Hand Surg Eur Vol

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We reviewed the outcomes of our dedicated clinic for suspected scaphoid fractures. The primary outcome measure was to test the reliability of accurately diagnosing an occult scaphoid fracture with a combination of anatomical snuff box, scaphoid tubercle, longitudinal compression tenderness, ulnar deviation and the pinch test. Cost savings of the new patient pathway was our secondary outcome measure. Between December 2016 and March 2020, 922 patients were recruited at a mean of 12 days post-injury. Sixty-five per cent ( n = 602) with a low clinical suspicion were discharged and 35% ( n = 320) with a high clinical suspicion had same day MRI scan. Fifty-eight scaphoid fractures were diagnosed and treated with no nonunions reported. Anatomical snuff box tenderness was the most sensitive test (90%). A combination of five tests better excluded an occult fracture (80% accuracy). The dedicated scaphoid clinic pathway resulted in 350 fewer follow-up visits and an overall saving of £59,666. Level of evidence: III

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“…4 Patients can develop nonunion, chronic pain with arthritis, or limitations in use of the wrist, leaving the emergency medicine provider with fear of litigation. 5 …”

Section: Commentarymentioning

confidence: 97%

What Physical Examination Findings and Diagnostic Imaging Modalities Are Most Useful in the Diagnosis of Scaphoid Fractures?

Gemme

Tubbs

2015

Annals of Emergency Medicine

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The litigation cost of negligent scaphoid fracture management

Cited by 27 publications

References 7 publications

Factors Associated With Physician Loss in Anterior Cruciate Ligament Reconstruction Malpractice Lawsuits

Factors Associated With Physician Loss in Anterior Cruciate Ligament Reconstruction Malpractice Lawsuits

Reliability of clinical tests for prediction of occult scaphoid fractures and cost benefit analysis of a dedicated scaphoid pathway

What Physical Examination Findings and Diagnostic Imaging Modalities Are Most Useful in the Diagnosis of Scaphoid Fractures?

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