title: Pediatric distal humeral fractures and complications of treatment in Finland: a review of compensation claims from 1990 through 2010.
abstract: BACKGROUND
  The distal part of the humerus is the second most common fracture location in children. Complications are more common than with other pediatric fractures and are mostly related to inappropriate diagnosis and treatment.
  
  
  METHODS
  On the basis of data from 1990 through 2010 in the national registry of inpatient care treatment in Finland, we calculated the number of children less than seventeen years of age who were treated under anesthesia for a distal humeral fracture (reduction with or without internal fixation) and the number of treatment institutions. We analyzed compensation claims concerning the treatment of these fractures that were received by the Patient Insurance Centre. The risk of a complication of treatment and the number of avoidable complications of treatment were assessed.
  
  
  RESULTS
  A total of 7909 children underwent a procedure under anesthesia to treat a distal humeral fracture. Claims were filed for 117 patients (118 fractures, including seventy-four supracondylar, nineteen epicondylar, nineteen condylar, and six T-type), and compensation was granted for eighty-three (71%) of the patients. Deformity (forty-nine), delayed treatment (twenty), nerve injury (seventeen), and infection (seven) were the most common reasons for compensation. On reevaluation of the claims, ninety patients were assessed as having had complications of treatment. In our opinion, complications could have been avoided for eighty-six (96%) of these patients.
  
  
  CONCLUSIONS
  We believe that improving the quality of primary assessment and operative technique would decrease the number of complications in the treatment of pediatric distal humeral fractures. Centralizing operative treatment to tertiary hospitals should be considered.
authors: Faculty of Medicine, Helsinki University, Tukholmankatu 8 B, 5th and 6th Floors, P.O. Box 20, FIN-00014 Helsinki, Finland. E-mail address: noora.vallila@hus.fi.
authors: Noora
authors: N
authors: Vallila
authors: Children's Hospital, Helsinki University Central Hospital, Stenbäckinkatu 11, P.O. Box 281, FIN-00029 HUS Helsinki, Finland. E-mail address for A. Sommarhem: antti.sommarhem@hus.fi. E-mail address for Y. Nietosvaara: yrjana.nietosvaara@hus.fi.
authors: Antti
authors: A
authors: Sommarhem
authors: Töölö Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, P.O. Box 266, FIN-00029 HUS Helsinki, Finland. E-mail address: mika.paavola@hus.fi.
authors: Mika
authors: M
authors: Paavola
authors: Children's Hospital, Helsinki University Central Hospital, Stenbäckinkatu 11, P.O. Box 281, FIN-00029 HUS Helsinki, Finland. E-mail address for A. Sommarhem: antti.sommarhem@hus.fi. E-mail address for Y. Nietosvaara: yrjana.nietosvaara@hus.fi.
authors: Yrjänä
authors: Y
authors: Nietosvaara
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D005592:Fracture Fixation / Q000009:adverse effects*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D007223:Infant; D007344:Insurance Claim Reporting; D008297:Male; D019300:Medical Errors / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies