[Medical responsibility in hand traumatology]

The apparently benign nature of many hand injuries may lead one to underestimate the potentially serious consequences of these injuries. In case of significant residuals, patients may consider themselves victims of inadequate treatment. The traumatic lesions may be classified into three groups of increasing severity (mild, moderate and severe emergencies) which require the services of increasingly sophisticated treatment teams: Services d'Accueil des Urgences (SAU) (general emergency care facilities) for minor injuries, general surgery emergency services for more severe injuries, and specialized teams such as the centers of the "Fédération Européenne des Services Urgences Mains" (FESUM) for serious complicated injuries. This differentiation is correlated to the level of expertise of the treatment team and the quality of the technical support at their disposition. Proper match of the severity of injury with the level of expertise of the treatment team can minimize the incidence of poor results and resultant litigation. Personalized treatment given with the informed consent of the patient, and his understanding that all necessary resources will be utilized, will lessen the tendency for the patient to consider some less than perfect results as the consequence of inadequate care, and therefore, lessen the likelihood of litigation against the physician or hospital. The evaluation of the permanent impairment should be analyzed as the difference between the actual result and similar, if not strictly identical cases given the appropriate level of treatment. In order to limit the frequency of litigation, including unjustified lawsuits, it is necessary, as a preventive measure, to integrate these precautions into the plan for provision of care for hand injuries.