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The Quality of Orthopaedic Care in 108 Upper Extremity
Malpractice Claims Filed and Claims Paid
Jerry I. Huang, MD; Linda S. Stephens, PhD; Jocelyn L. Jette, BS; Winston J. Warme, MD; Karen L. Posner, PhD; Frederick A. Matsen, MD1

University of Washington, Seattle, WA

Introduction: Orthopaedic malpractice claims allege injuries resulting from substandard care. Such claims can reveal opportunities for practice improvement. There has been no systematic study of the characteristics of upper extremity malpractice claims. We sought to identify features of a large series of claims to guide efforts in improving the safety of upper extremity orthopaedic care and reduce the frequency of paid malpractice claims.

Methods: One hundred and eight closed claims from a national insurer were investigated by a team of three orthopaedic surgeons and three investigators experienced in closed claims research.

Results: Malpractice claims were primarily for the care of common upper extremity problems, rather than unusual or especially difficult diagnoses. Most of claims filed and most of the claims with payment were for adverse outcomes that were possibly preventable: nonunion or malunion of fractures, nerve injury, and infection. Over 40% of the claims (57% of claims paid) were those that required additional surgery. Issues relating to the quality of care were significantly more common for cases involving fracture management (p<.0005). Claims were significantly related to the skill and practice quality of the surgeon, especially for claims resulting in payment. In the non-payment group 57% of the factors leading to the claim were under the surgeonís control, whereas in the payment group, 97% of these factors were under the control of the surgeon.

Discussion: In view of the observation that upper extremity malpractice claims and claims paid are often related to alleged substandard treatment of common conditions, especially fractures, there appears to be a need to assure that treating orthopaedic surgeons have the education and fundamental skills to manage the patients that come under their care, adhere to expected patterns of practice, and have a low threshold for consultation when they are drawn outside their area of experience. Improving the quality of care of these conditions can be expected to reduce the number of upper extremity malpractice claims and claims paid.

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