title: Injuries as a result of treatment of tibial fractures in children: Claims for compensation submitted to the Patient Insurance Center in Finland.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. sauli.palmu@helsinki.fi
authors.forename: Sauli
authors.initials: S
authors.lastname: Palmu
authors.forename: Reijo
authors.initials: R
authors.lastname: Paukku
authors.forename: Mervi K
authors.initials: MK
authors.lastname: Mäyränpää
authors.forename: Jari
authors.initials: J
authors.lastname: Peltonen
authors.forename: Yrjänä
authors.initials: Y
authors.lastname: Nietosvaara
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005260:Female; D005387:Finland; D005592:Fracture Fixation / Q000009:adverse effects* / Q000592:standards; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000592:standards; D006801:Humans; D007049:Iatrogenic Disease; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D019300:Medical Errors / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000175:diagnosis / Q000601:surgery*