Injuries as a result of treatment of tibial fractures in children

Figures & data

Figure 1. The claims-handling process of the Patient Insurance Center.

Figure 2. Compensation rates by method of treatment after pediatric tibial fracture treatment. no: no treatment initially; nonop.: nonoperative treatment; op.: operative treatment.

Table 1. Complications (n = 37) in 31/50 patients who claimed compensation after treatment. The numbers of cases who received compensation are given in parentheses

Complication	Treatment
	operative	nonoperative
Infection	8 (6)	2 (2)
Skin ulceration
casting		7 (7)
tourniquet	1 (1)
Compartment syndrome	6 (3)
Nerve palsy
peroneal	5 (5)
ulnar	1 (1)
Popliteal artery injury	1 (1)
Malunion		4 (3)
Nonunion		2 (1)
Total	22 (17)	15 (13)

Table 2. Details of the causes of the 32 treatment injuries that led to compensation

	n	avoidable
Delay	15	14
diagnosis	11	10/11
fasciotomy	3	yes
remanipulation	1	yes
Casting technique	9	8
decubitus heel	4	yes
decubitus (ankle)	1	yes
decubitus (combined)	1	yes
skin laceration (cast removal)	1	yes
malunion	2	1/2
Operative technique	6	6
iatrogenic peroneal palsy	2	yes
inadequate implant	2	yes
inadequate reduction	1	yes
skin necrosis caused by tourniquet	1	yes
Patient position during anesthesia	2	2
ulnar palsy	1	yes
peroneal palsy	1	yes

Table 3. Characteristics of 50 claims for compensation concerning injuries resulting from treatment of tibial fractures in children, listed according to type of institution, and their rates of compensation

	No. of claims	No. compensated
Private clinic	1	1
skin laceration during cast removal	1	1
Healthcare center	12	9
missed diagnosis (no radiographs)	7	5 ^a
fracture missed on radiographs	3	3
malunion	1	1
fracture could not be seen on radiograph	1	0
District hospital	5	4
decubitus (inadequate casting)	2	2
malunion	2	1 ^b
operative technique	1	1
Central hospital	16	12
decubitus (inadequate casting)	3	3
operative technique	2	2
infection	2	2
iatrogenic nerve injury	2	2
missed diagnosis (no radiographs)	1	1
delay in fasciotomy	1	1
malunion – no treatment	1	1
inadequate clinical examination	1	0 ^c
reduced range of motion	3	0
University hospital	16	9
infection	3	1
iatrogenic nerve injury	3	2
delay in fasciotomy	2	2
delay in arterioraphy	1	1
missed diagnosis (no radiographs)	1	1
decubitus (inadequate casting)	1	1
skin necrosis caused by tourniquet	1	1
remanipulation under anesthesia	1	0 ^d
compartment syndrome	1	0 ^e
pseudarthrosis	1	0 ^e
fracture missed on radiographs	1	0 ^d

^a Injury regarded as tolerable.

^b Malunion within acceptable limits.

^c Minor injury.

^d Treatment injury had no affect on the final outcome.

^e Complication was caused by the primary injury.