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Wrong-Bone Excision in Hand Surgery.

Nicholas M Caggiano1, David L Nelson2, Saul J Kaplan3

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Wrong-bone excision occurs in hand surgery, with scaphoid removal during trapeziectomy being the most common error. Identifying landmarks is key to prevention.

Keywords:
hand surgerymedical errorsmedical malpractice

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Area of Science:

  • Orthopedic Surgery
  • Surgical Safety
  • Hand Surgery

Background:

  • Wrong-bone excision is an unknown complication in hand surgery.
  • The wrist's anatomy presents challenges for surgical site marking.
  • Mistaken identification of wrist structures is a potential issue.

Purpose of the Study:

  • To evaluate the incidence of wrong-bone excision in hand surgery.
  • To identify risk factors and preventative measures for this complication.

Main Methods:

  • An anonymous online survey was designed.
  • The survey targeted 777 hand surgeons via email.
  • The survey assessed occurrence, risk factors, medicolegal outcomes, and prevention.

Main Results:

  • Ninety-nine surgeons responded, with 23 reporting wrong-bone excision.
  • The most frequent error was scaphoid excision during planned trapezium excision.
  • Inadequate visualization, localization, and resident teaching were cited as contributing factors.

Conclusions:

  • Wrong-bone excision has a non-zero incidence in hand surgery.
  • Incorrect scaphoid excision during trapeziectomy is the most common error.
  • Identifying landmarks is the most effective preventative strategy.