title: The quality of upper extremity orthopedic care in liability claims filed and claims paid.
abstract: OBJECTIVE
  To review a series of closed liability claims for upper extremity conditions to guide improvements for upper extremity care and thereby reduce the frequency of paid claims.
  
  
  METHODS
  The authors, a team of 3 orthopedic surgeons and 3 nonphysician investigators experienced in closed claims research, investigated 108 closed upper extremity liability claims from a large United States-wide insurer for events that occurred between 1996 and 2009. We sought to determine the types of conditions, treatments, and surgeon factors common to claims made and claims paid.
  
  
  RESULTS
  Liability claims were primarily for the care of common problems, such as fractures (n = 52; 48%) or degenerative conditions (n = 24; 26%), rather than complex challenging conditions or disorders, such as deficiencies treated with replantations or tissue transfers. The most common adverse outcomes in these claims were nonunion or malunion of fractures (n = 29; 27%), nerve injury (n = 20; 19%), and infection (n = 13; 12%). Most claims (n = 57; 53%) involved a permanent injury. The surgeon's operative skills were more commonly an issue in paid claims (n = 13; 45%) than in claims without payment (n = 14; 19%). Claims for mismanagement of fractures (n = 52; 48% of all claims) were more likely to result in payment (n = 20; 38%) than nonfracture claims (n = 10; 18%).
  
  
  CONCLUSIONS
  This analysis suggests that the incidence of upper extremity claims made and claims paid may be reduced if surgeons acquire and maintain the knowledge and skills necessary for the care of the common conditions they encounter, including fractures.
  
  
  METHODS
  Prognostic II.
authors: Department of Orthopaedics and Sports Medicine and the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.. Electronic address: matsen@u.washington.edu.
authors: Frederick A
authors: FA
authors: Matsen
authors: Department of Orthopaedics and Sports Medicine and the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
authors: Linda
authors: L
authors: Stephens
authors: Department of Orthopaedics and Sports Medicine and the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
authors: Jocelyn L
authors: JL
authors: Jette
authors: Department of Orthopaedics and Sports Medicine and the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
authors: Winston J
authors: WJ
authors: Warme
authors: Department of Orthopaedics and Sports Medicine and the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
authors: Jerry I
authors: JI
authors: Huang
authors: Department of Orthopaedics and Sports Medicine and the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
authors: Karen L
authors: KL
authors: Posner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm / Q000601:surgery*; D002983:Clinical Competence / Q000331:legislation & jurisprudence; D035881:Compensation and Redress / Q000331:legislation & jurisprudence*; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005260:Female; D050723:Fractures, Bone / Q000601:surgery; D006225:Hand / Q000601:surgery*; D006801:Humans; D007351:Insurance, Liability / Q000331:legislation & jurisprudence; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: Malpractice; practice patterns; professional liability; surgeon skill; upper extremity