a Department of Orthopaedics and Traumatology , Helsinki University Central Hospital and University of Helsinki , Helsinki.
b Department of Hand Surgery , Helsinki University Hospital and University of Helsinki , Helsinki.
Acta Orthop. 2018 Apr;89(2):240-245. doi: 10.1080/17453674.2018.1427966. Epub 2018 Jan 22.
Background and purpose - Optimal treatment for distal radius fractures remains controversial, with a significant number of fractures resulting in complications and long-term morbidity. We investigated patient injury claims related to distal radius fractures to detect the critical steps in the treatment leading to avoidable adverse events Patients and methods - We analyzed all compensated patient injury claims in Finland between 2007 and 2011. Claims were collected from the Patient Insurance Center's (PIC) nationwide claim register. Patients of all ages were included. Each claim decision, original patient records, and radiographs related to treatment were reviewed. Results - During the study period, the PIC received 584 claims regarding distal radius fractures, of which 208 (36%) were compensated. Pain and impaired wrist function were the most common subjective reasons to file claims among compensated patients. In 66/208 patients, more than 1 adverse event leading to patient injury was detected. The detected adverse events could be divided into 3 main groups: diagnostic errors (36%, n = 103), decision/planning errors (30%, n = 87), and insufficient technical execution (32%, n = 91). Issues related to malalignment were the main concerns in each group. Diagnostic errors were often related to incorrect assessment of the fracture (re)displacement (75%, n = 78). All of the decision-making errors concerned physicians' decisions to accept unsatisfactory fracture alignment. The most common technical error was insufficient reduction (29%, n = 26). Interpretation - We identified avoidable adverse events behind patient injuries related to distal radius fracture treatment. This study will help physicians to recognize the critical steps in the treatment of this common fracture and enhance patient safety.
背景与目的-桡骨远端骨折的最佳治疗方法仍存在争议，许多骨折导致并发症和长期发病。我们研究了与桡骨远端骨折相关的患者伤害索赔，以发现导致可避免不良事件的治疗关键步骤。
患者与方法-我们分析了芬兰在 2007 年至 2011 年间所有已赔偿的患者伤害索赔。索赔信息来自于患者保险中心（PIC）的全国索赔登记处。所有年龄段的患者均包含在内。审查了每个索赔决定、原始患者记录和与治疗相关的 X 光片。
结果-在研究期间，PIC 收到了 584 份关于桡骨远端骨折的索赔，其中 208 份（36%）获得了赔偿。疼痛和腕关节功能受损是获得赔偿的患者中最常见的主观索赔原因。在 66/208 名患者中，发现了超过 1 个导致患者受伤的不良事件。所发现的不良事件可分为 3 个主要组：诊断错误（36%，n=103）、决策/计划错误（30%，n=87）和技术执行不足（32%，n=91）。每组的主要关注点都是对线不良问题。诊断错误通常与骨折（再）移位的不正确评估有关（75%，n=78）。所有决策错误都涉及医生接受不满意的骨折对线的决定。最常见的技术错误是复位不足（29%，n=26）。
结论-我们发现桡骨远端骨折治疗相关患者伤害背后存在可避免的不良事件。本研究将帮助医生识别这种常见骨折治疗中的关键步骤，并提高患者安全性。
