Malpractice trends in shoulder and elbow surgery
These authors sought to examine trends in malpractice claims in shoulder and elbow surgery. They queried the Westlaw online legal database to identify state and federal jury verdicts and settlements pertaining to shoulder and elbow surgery from 2010-2020 in which an orthopedic shoulder and elbow
surgeon was a named defendant.
Twenty-five such malpractice lawsuits were identified. Most plaintiffs in these cases were adult men, and the majority of cases were filed in the Southwest (28%) and Midwest (28%) regions of the United States.
The most common anatomic region involved in claims was the rotator cuff (32%), followed by the glenohumeral joint (20%).
56% of these claims involved surgery. Post-treatment residual pain of mechanical nature was the most common complication seen in claims (56%) followed by complaints of nerve damage.
A large portion of claims resulted after nonoperative treatment.
The jury ruled in favor of the defendant surgeon in most cases (80%).
Comment: Two prior papers with larger case numbers deserve review.
These authors investigated 464 consecutive closed malpractice claims from the nation's largest insurer of medical liability. Their analysis revealed major concerns regarding patient safety within this series of malpractice claims. One-third of the claims alleged permanent disabling injuries, including amputations, brain damage, and major nerve damage. The highest impact allegations were failure to protect structures in the surgical field (41% of total payments to plaintiffs, 15% of all claims) and failure to prevent, diagnose, and/or treat complications of treatment (16% of total payments, 7% of all claims). Failure of implant positioning was commonly alleged in joint arthroplasty. In claims related to fracture care, the most common allegations were related to malunions, nonunions, dislocations, failure to protect structures in the surgical field, infection, and treatment complications.
These authors investigated 108 closed upper extremity liability claims from a large United States-wide insurer. 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, unusual conditions. 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%).
To recap, the common reasons for a malpractice lawsuit were delay in diagnosis and treatment, infection, nerve injury, substandard postoperative care and an improper clinical exam. Of course underlying all of this is establishing and maintaining a good relationship and communication between the patient and the surgeon, starting before surgery with a thorough evaluation with a frank discussion of the alternative treatments and extending through the followup period.
Shoulder arthritis - what you need to know (see this link) The smooth and move for irreparable cuff tears (see this link) The total shoulder arthroplasty (see this link). The ream and run technique is shown in this link. The cuff tear arthropathy arthroplasty (see this link). The reverse total shoulder arthroplasty (see this link). Shoulder rehabilitation exercises (see this link).Follow on twitter: Frederick Matsen (@shoulderarth)
