July 1995 Bulletin

A minute with malpractice

by Dale R. Butler, MD

The Academy's Committee on Professional Liability has reviewed closed malpractice claims on the treatment of tibia fractures. The most common causes of suit were: nonunion, malunion, infection, leg length discrepancy, and skin injury.

A surprisingly high number of the nonunion and malunion suits involved tibial plateau fractures. Vascular and compartment syndrome problems were infrequent, but they involved the largest payouts. Infection and skin injury were resolved with no indemnity payout.

What can orthopaedic surgeons do to reduce the chances of a lawsuit? Informed consent and patient education may forestall a suit for nonunion, malunion, or leg length discrepancy. Include these complications in your preoperative discussions. Infection and skin injury suits are defensible if recognized early, documented, and treated appropriately with culture and antibiotics. Document severely bruised or injured skin that could lead to skin loss and recognize compartment syndrome early. There is no place for "denial."

Communicate with your patients early and frequently and document your communication.

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