[Does the hand solely belong in the hands of a qualified hand surgeon?]

Background In Germany, Hand Surgery is an additional qualification that can only be obtained by a three-year training after a completed residency in General Surgery, Plastic Surgery or Trauma and Orthopaedic Surgery. Nevertheless, injuries and diseases of the hand are also treated by physicians without this particular qualification. It is questionable whether these treatments more often lead to medical malpractice. Material and Methods 376 charges of medical malpractice in surgical treatments of the hand and forearm that were closed in 2014 and 2015 were collected by the Arbitration Board for Medical Liability Issues of the Medical Association of North Germany.Cases with proven medical malpractice were classified by the qualification of the physician in charge and analysed. A statistical analysis was performed with the use of the program SPSS (IBM). Results Medical malpractice was proven in 42 of 113 cases with an attending physician who held the additional qualification for Hand Surgery (37.2 %). For physicians without this qualification, the figures were 79 out of 155 (51.0 %) in the group of trauma and orthopaedic surgeons and 54 out of 108 (50.0 %) in the group of general surgeons. The differences between the hand surgeons and the trauma and orthopaedic surgeons (p = 0.017) and between hand surgeons and general surgeons were significant (p = 0.037). Conclusions It was shown that physicians with an additional qualification in hand surgery had signifcantly fewer proven medical malpratice cases than physicians without this qualification. The following trends were observed in the cases of the physicians without the additional qualification in hand surgery: underestimation of the severity of trauma to soft tissues and infections of the hand, errors in the surgical examination of the hand, including functional tests of tendons and nerves, as well as in diagnostic findings after X-ray studies of the hand.