title: Negligence claims following non-union and malunion of long bone fractures: An analysis of 15 years of data.
abstract: BACKGROUND
  Non-unions and malunions are recognised to be complications of the treatment of long bone fractures. No previous work has looked at the implications of these complications from a medicolegal perspective.
  
  
  METHODS
  A complete database of litigation claims in Trauma and Orthopaedic Surgery was obtained from the NHS Litigation Authority. Two separate modalities of the treatment of long bone fractures were examined i) non-union and ii) acquired deformity. The type of complaint, whether defended or not, and costs were analysed.
  
  
  RESULTS
  There were claims of which 97 related to non-union and 32 related to postoperative limb deformity. The total cost was £8.2 million over a 15-year period in England and Wales. Femoral and tibial non-unions were more expensive particularly if they resulted in amputation. Rotational deformity cost nearly twice as much as angulation deformities.
  
  
  CONCLUSIONS
  The cosmetic appearances of rotational malalignment and amputation results in higher compensation; this reinforces an outward perception of outcome as being more important than harmful effects. Notwithstanding the limitations of this database, there are clinical lessons to be gained from these litigation claims.
authors.affiliation: Limb Reconstruction Service, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom. Electronic address: c.w.metcalfe89@gmail.com.
authors.forename: C W
authors.initials: CW
authors.lastname: Metcalfe
authors.affiliation: Limb Reconstruction Service, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom.
authors.forename: W D
authors.initials: WD
authors.lastname: Harrison
authors.affiliation: Limb Reconstruction Service, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Nayagam
authors.affiliation: Limb Reconstruction Service, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Narayan
mesh_terms: D035881:Compensation and Redress / Q000331:legislation & jurisprudence*; D004954:Esthetics; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods; D050723:Fractures, Bone / Q000503:physiopathology / Q000601:surgery*; D005599:Fractures, Ununited / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery; D006801:Humans; D016365:Liability, Legal; D008318:Malpractice / Q000191:economics / Q000331:legislation & jurisprudence*; D019637:Orthopedic Procedures; D009985:Orthopedics / Q000191:economics / Q000331:legislation & jurisprudence*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000503:physiopathology* / Q000523:psychology; D012189:Retrospective Studies; D013222:State Medicine / Q000331:legislation & jurisprudence; D006113:United Kingdom
keywords: Deformity; Limb reconstruction; Litigation; Malunion; Nonunion