A closed-claim analysis of complaints after paediatric antebrachial fractures

Antebrachial fractures in children (AFC) are common and account for one third of all paediatric fractures. The Danish Patient Compensation Association (PCA) receives complaints from patients who believe that they have sustained injuries due to potential malpractice or unfortunate circumstances. Case files on AFC from the PCA were assessed to identify causality and factors contributing to complaints and potential malpractice.

A closed-claim analysis was performed in 138 cases with the diagnosis codes DS52.2 through DS52.6.

The most frequent complaints were fracture re-displacement (n = 49) and dissatisfaction with an otherwise correctly treated injury (n = 30). Doctor's delay due to missed primary diagnosis was found to be a median of 63 days. Complaints about surgery were almost equally distributed between K-wire and intramedullary nails, and unequally distributed for conservative treatment between splinting (n = 29) and casting (n = 10). Two thirds of the in-juries were unacknowledged and evaluated as light injuries or no injury. One third of the complaints were acknowledged; the majority of which were both-bone fractures.

Two thirds of all complaints were due to normal fracture sequelae; thus, patient anticipation should be accommodated by thorough patient information. Mid-diaphyseal fractures of the forearm are overrepresented among the acknowledged complaints. Casting seems to be preferred to splinting. However, more awareness of these fractures using routinely performed radiographs at the first visit to the emergency room and at follow-up could avoid complaints as well as doctor's delay.

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