Trends in Negligent Treatment of Distal Radius Fractures

June 3, 2014
Jeannette Y. Wick, RPh, MBA, FASCP

Surgical Rounds®, June 2014,

The high volume of distal radius procedures combined with an elevated risk for adverse outcomes such as malunion, loss of radial length, inclination, and volar or dorsal angulation make surgeries in the forearm ripe for malpractice claims.

Roughly 18% of human skeletal fractures occur at the distal radius (DR), making it the most common fracture of all. The high volume of DR procedures combined with an elevated risk for adverse outcomes such as malunion, loss of radial length, inclination, and volar or dorsal angulation make surgeries in the forearm ripe for malpractice claims.

Surgeons from the Starr Hand Surgery Center at St. Luke’s-Roosevelt Hospital in New York recently reviewed a lawsuit database to identify patterns in DR fracture malpractice. The surgeons mainly believed malunions resulting from nonsurgical treatment would precipitate the most claims, though they were also interested in costs associated with claims, independent risk factors for making indemnity payments, and other trends.

The authors examined data from 70 closed malpractice claims filed for alleged negligent treatment of DR fractures by orthopedic surgeons insured by New York’s largest medical professional liability insurer. The cases spanned from 1981 to 2005, though each defendant’s personal closed malpractice claim history from 1975 to 2011 was also retrieved and reviewed.

Overall, the incidence of malpractice claims for DR fracture management was low, but just as the researchers hypothesized, patient complaints most often involved malunion regardless of treatment type.

Over the years, claims for surgically treated fractures increased — most of which concerned poor doctor-patient relationships, though other issues included inadequate follow-up and/or patients’ noncompliance, poor explanation of treatment options, and verbal arguments.

According to the surgeon authors, women experienced 3.3 times more forearm and wrist fractures than men and were more likely to file suit. However, age predicted lawsuits among men, as male plaintiffs were significantly older than the average male treated for DR fractures in the state.

Very few surgeon defendants were fellowship-trained in hand surgery and most had histories of multiple malpractice suits, with an average of 9. According to the authors, more than half of the cases resulted in indemnity payments with a median total of $440,000, and those who were not certified by the American Board of Orthopedic Surgery (ABOS) were significantly more likely to make indemnity payments.