Palmu Sauli, Paukku Reijo, Mäyränpää Mervi K, Peltonen Jari, Nietosvaara Yrjänä
Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Acta Orthop. 2009 Feb;80(1):78-82. doi: 10.1080/17453670902805080.
Tibial fractures comprise 10% of all fractures in children. To our knowledge there have been no previous reports of treatment injuries in these fractures. We analyzed compensation claims concerning treatment of these fractures in Finland. We used this information to determine preventable causes of treatment injuries.
In Finland, the Patient Insurance Center (PIC) provides financial compensation for patients who have sustained an injury in connection with medical treatment or operation. We retrospectively analyzed all claims for compensation arising from treatment of tibial fractures in children that had been received by the PIC between 1997 and 2004. The mode of treatment, complications, and permanent sequelae were assessed. We also estimated the number of avoidable treatment injuries.
The PIC received 50 claims for compensation during the 8-year study period. The claims were based on the following issues: pain, incorrect diagnosis and treatment, permanent disability, extra treatment expenses, inappropriate behavior of the medical personnel, and loss of income of the parents. 35/50 claims had received compensation, of which 32 were related to the treatment and 3 to infections. The treatment injuries that had led to compensation comprised a delay in diagnosis and treatment in 15 patients, inappropriate casting in 9, inappropriate operative treatment in 5, and other causes in 3 patients. An unsatisfactory standard of treatment and missed diagnosis were the most common reasons for compensation. In restrospect, all but 1 of the 35 injuries that had led to compensation were considered to be avoidable.
胫骨骨折占儿童骨折总数的10%。据我们所知，此前尚无关于这些骨折治疗损伤的报告。我们分析了芬兰有关这些骨折治疗的赔偿申请。我们利用这些信息来确定治疗损伤的可预防原因。
在芬兰，患者保险中心（PIC）为因医疗治疗或手术而受伤的患者提供经济赔偿。我们回顾性分析了1997年至2004年间PIC收到的所有因儿童胫骨骨折治疗而产生的赔偿申请。评估了治疗方式、并发症和永久性后遗症。我们还估计了可避免的治疗损伤数量。
在8年的研究期间，PIC收到了50份赔偿申请。这些申请基于以下问题：疼痛、诊断和治疗错误、永久性残疾、额外治疗费用、医务人员的不当行为以及父母的收入损失。50份申请中有35份获得了赔偿，其中32份与治疗有关，3份与感染有关。导致赔偿的治疗损伤包括15例诊断和治疗延迟、9例石膏固定不当、5例手术治疗不当以及3例其他原因。治疗标准不令人满意和漏诊是赔偿的最常见原因。回顾来看，导致赔偿的35例损伤中除1例之外均被认为是可避免的。
