Malpractice in distal radius fracture management: an analysis of closed claims.
OBJECTIVE
Distal radius fractures comprise the majority of hand- and wrist-related malpractice claims. We hypothesized that a majority of lawsuits would be for malunions resulting from nonsurgical treatment. Additional goals of this study were to quantify costs associated with claims, determine independent risk factors for making an indemnity payment, and illustrate trends over time.


METHODS
Seventy closed malpractice claims filed for alleged negligent treatment of distal radius fractures by orthopedic surgeons insured by the largest medical professional liability insurer in New York State (NYS) from 1981 to 2005 were reviewed. We separately reviewed defendants' personal closed malpractice claim histories from 1975 to 2011. Overall incidence of malpractice claims among distal radius fractures treated in NYS was calculated using the NYS Statewide Planning and Research Cooperative System database and the 2008 American Academy of Orthopedic Surgeons census data.


RESULTS
The overall incidence of malpractice claims for distal radius fracture management was low. Malunion was the most common complaint across claims regardless of treatment type. Claims for surgically treated fractures increased over time. A majority of claims documented poor doctor-patient relationships. Male plaintiffs in this group were significantly older than males treated for distal radius fractures in NYS. Most defendants had a history of multiple malpractice suits, all were male, and only a small percentage were fellowship-trained in hand surgery. Defendants lacking American Board of Orthopedic Surgery certification were significantly more likely to make indemnity payments. Thirty-eight of 70 cases resulted in an indemnity payment.


CONCLUSIONS
Malunion and poor doctor-patient relationships are the major features of malpractice litigation involving distal radius fracture management. Older defendant age and lack of American Board of Orthopedic Surgery certification increase the likelihood of making an indemnity payment.


METHODS
Economic and decision analyses II.
C.V. Starr Hand Surgery Center, St. Luke's-Roosevelt Hospital, New York, New York. Electronic address: pdenoble@gmail.com.
Peter H
PH
DeNoble
C.V. Starr Hand Surgery Center, St. Luke's-Roosevelt Hospital, New York, New York.
Astrid C
AC
Marshall
C.V. Starr Hand Surgery Center, St. Luke's-Roosevelt Hospital, New York, New York.
O Alton
OA
Barron
C.V. Starr Hand Surgery Center, St. Luke's-Roosevelt Hospital, New York, New York.
Louis W
LW
Catalano
C.V. Starr Hand Surgery Center, St. Luke's-Roosevelt Hospital, New York, New York.
Steven Z
SZ
Glickel
D000328:Adult; D002568:Certification; D017759:Fractures, Malunited / Q000191:economics*; D006801:Humans; D016365:Liability, Legal / Q000191:economics; D008297:Male; D008318:Malpractice / Q000191:economics* / Q000331:legislation & jurisprudence; D008875:Middle Aged; D009518:New York; D010817:Physician-Patient Relations; D011885:Radius Fractures / Q000191:economics*; D012307:Risk Factors
Distal radius; malpractice; malunions; nonsurgical