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Injuries as a result of treatment of tibial fractures in children: Claims for compensation submitted to the Patient Insurance Center in Finland.

Palmu S, Paukku R, Mäyränpää MK, Peltonen J, Nietosvaara Y - Acta Orthop (2009)

Bottom Line: The treatment injuries that had led to compensation comprised a delay in diagnosis and treatment in 15 patients, inappropriate casting in 9, inappropriate operative treatment in 5, and other causes in 3 patients.An unsatisfactory standard of treatment and missed diagnosis were the most common reasons for compensation.In restrospect, all but 1 of the 35 injuries that had led to compensation were considered to be avoidable.

View Article: PubMed Central - PubMed

Affiliation: Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. sauli.palmu@helsinki.fi

ABSTRACT

Background and purpose: Tibial fractures comprise 10% of all fractures in children. To our knowledge there have been no previous reports of treatment injuries in these fractures. We analyzed compensation claims concerning treatment of these fractures in Finland. We used this information to determine preventable causes of treatment injuries.

Material and methods: In Finland, the Patient Insurance Center (PIC) provides financial compensation for patients who have sustained an injury in connection with medical treatment or operation. We retrospectively analyzed all claims for compensation arising from treatment of tibial fractures in children that had been received by the PIC between 1997 and 2004. The mode of treatment, complications, and permanent sequelae were assessed. We also estimated the number of avoidable treatment injuries.

Results and interpretation: The PIC received 50 claims for compensation during the 8-year study period. The claims were based on the following issues: pain, incorrect diagnosis and treatment, permanent disability, extra treatment expenses, inappropriate behavior of the medical personnel, and loss of income of the parents. 35/50 claims had received compensation, of which 32 were related to the treatment and 3 to infections. The treatment injuries that had led to compensation comprised a delay in diagnosis and treatment in 15 patients, inappropriate casting in 9, inappropriate operative treatment in 5, and other causes in 3 patients. An unsatisfactory standard of treatment and missed diagnosis were the most common reasons for compensation. In restrospect, all but 1 of the 35 injuries that had led to compensation were considered to be avoidable.

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Compensation rates by method of treatment after pediatric tibial fracture treatment. no: no treatment initially; nonop.: nonoperative treatment; op.: operative treatment.
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Figure 0002: Compensation rates by method of treatment after pediatric tibial fracture treatment. no: no treatment initially; nonop.: nonoperative treatment; op.: operative treatment.

Mentions: Primary treatment was performed by cast immobilization in 25 patients and by operative means in 14. The fracture diagnosis was initially missed in 11 patients: 1 patient was later operated, 6 were treated by casting, and 4 did not need any treatment at the time of correct diagnosis (Figure 2). Primary operative treatment included 5 screw fixations, 3 flexible intramedullary (IM) nailing, 3 rigid IM nailing, 1 plate-osteosynthesis, 1 external fixation, and 1 bio-absorbable pinning. 3 of these patients were reoperated: 1 flexible nailing was converted to rigid IM nailing, and 1 rigid IM nail and 1 plate osteosynthesis were both converted to external fixation. 14/25 of the primarily nonoperatively treated patients were eventually operated.


Injuries as a result of treatment of tibial fractures in children: Claims for compensation submitted to the Patient Insurance Center in Finland.

Palmu S, Paukku R, Mäyränpää MK, Peltonen J, Nietosvaara Y - Acta Orthop (2009)

Compensation rates by method of treatment after pediatric tibial fracture treatment. no: no treatment initially; nonop.: nonoperative treatment; op.: operative treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823237&req=5

Figure 0002: Compensation rates by method of treatment after pediatric tibial fracture treatment. no: no treatment initially; nonop.: nonoperative treatment; op.: operative treatment.
Mentions: Primary treatment was performed by cast immobilization in 25 patients and by operative means in 14. The fracture diagnosis was initially missed in 11 patients: 1 patient was later operated, 6 were treated by casting, and 4 did not need any treatment at the time of correct diagnosis (Figure 2). Primary operative treatment included 5 screw fixations, 3 flexible intramedullary (IM) nailing, 3 rigid IM nailing, 1 plate-osteosynthesis, 1 external fixation, and 1 bio-absorbable pinning. 3 of these patients were reoperated: 1 flexible nailing was converted to rigid IM nailing, and 1 rigid IM nail and 1 plate osteosynthesis were both converted to external fixation. 14/25 of the primarily nonoperatively treated patients were eventually operated.

Bottom Line: The treatment injuries that had led to compensation comprised a delay in diagnosis and treatment in 15 patients, inappropriate casting in 9, inappropriate operative treatment in 5, and other causes in 3 patients.An unsatisfactory standard of treatment and missed diagnosis were the most common reasons for compensation.In restrospect, all but 1 of the 35 injuries that had led to compensation were considered to be avoidable.

View Article: PubMed Central - PubMed

Affiliation: Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. sauli.palmu@helsinki.fi

ABSTRACT

Background and purpose: Tibial fractures comprise 10% of all fractures in children. To our knowledge there have been no previous reports of treatment injuries in these fractures. We analyzed compensation claims concerning treatment of these fractures in Finland. We used this information to determine preventable causes of treatment injuries.

Material and methods: In Finland, the Patient Insurance Center (PIC) provides financial compensation for patients who have sustained an injury in connection with medical treatment or operation. We retrospectively analyzed all claims for compensation arising from treatment of tibial fractures in children that had been received by the PIC between 1997 and 2004. The mode of treatment, complications, and permanent sequelae were assessed. We also estimated the number of avoidable treatment injuries.

Results and interpretation: The PIC received 50 claims for compensation during the 8-year study period. The claims were based on the following issues: pain, incorrect diagnosis and treatment, permanent disability, extra treatment expenses, inappropriate behavior of the medical personnel, and loss of income of the parents. 35/50 claims had received compensation, of which 32 were related to the treatment and 3 to infections. The treatment injuries that had led to compensation comprised a delay in diagnosis and treatment in 15 patients, inappropriate casting in 9, inappropriate operative treatment in 5, and other causes in 3 patients. An unsatisfactory standard of treatment and missed diagnosis were the most common reasons for compensation. In restrospect, all but 1 of the 35 injuries that had led to compensation were considered to be avoidable.

Show MeSH
Related in: MedlinePlus