Caggiano Nicholas M, Nelson David L, Kaplan Saul J, Matullo Kristofer S
1 St. Luke's University Hospital, Bethlehem, PA, USA.
2 Private Practice, Greenbrae, CA, USA.
Hand (N Y). 2017 Sep;12(5):467-470. doi: 10.1177/1558944716672202. Epub 2016 Oct 3.
The incidence of wrong-bone excision in hand surgery is not known. The wrist offers a unique challenge in that a single surgical incision yields access to multiple potential surgical sites, thus rendering site marking less effective. Mistaken identification of structures in the wrist is a real and potentially troublesome phenomenon. This study is designed to evaluate the occurrence of wrong-bone excision and to identify any risk factors and preventative measures that may help to prevent this complication in the future.
We designed an anonymous online survey to determine the occurrence, risk factors, medicolegal outcomes, and preventative measures of wrong-bone excision. We distributed the survey to 777 hand surgeons via email.
Ninety-nine surgeons responded to our survey. Twenty-three respondents had participated in an excision of the incorrect bone in the wrist. The most common error was partial or complete excision of the scaphoid during a planned excision of the trapezium. Respondents indicated that inadequate visualization, inadequate localization, and teaching of a resident or fellow contributed to the error. There was only 1 case of legal action.
The results of our survey indicate that there exists a non-zero incidence of wrong-bone excision in hand surgery. The most common mistake is incorrect excision of the scaphoid during a planned trapeziectomy. Most surgeons feel that their patients were pleased with their outcome despite this complication, and legal action is rare. Deliberate identification of known landmarks was identified as the most useful strategy in preventing wrong-bone excision.
手部手术中误切骨骼的发生率尚不清楚。腕部手术面临着独特的挑战，因为单一手术切口可通向多个潜在手术部位，从而使手术部位标记效果欠佳。腕部结构的错误识别是一个切实存在且可能造成麻烦的现象。本研究旨在评估误切骨骼的发生率，并确定有助于预防未来该并发症的任何风险因素和预防措施。
我们设计了一项匿名在线调查，以确定误切骨骼的发生率、风险因素、法医学结果和预防措施。我们通过电子邮件向777名手外科医生发放了调查问卷。
99名外科医生回复了我们的调查。23名受访者曾参与过腕部误切骨骼的手术。最常见的错误是在计划切除大多角骨时部分或完全切除了舟骨。受访者表示，视野不佳、定位不准确以及对住院医师或进修医生的带教导致了这一错误。仅有1例引发了法律诉讼。
我们的调查结果表明，手部手术中存在一定比例的误切骨骼情况。最常见的错误是在计划进行大多角骨切除术时误切舟骨。尽管出现了这种并发症，但大多数外科医生认为他们的患者对手术结果感到满意，且很少引发法律诉讼。刻意识别已知标志被认为是预防误切骨骼最有效的策略。
