Dr. Knight is a board-certified orthopedic surgeon, a qualified forensic pathologist, and has served on the defense side in major cases. Dr. Knight has been an expert on many high-profile cases nationwide, ranging from product liability to medical malpractice. His experience and knowledge of testimony led to many very favorable settlements outside the courtroom. For cases that go before a jury, the site for which Dr. Knight testified has a 99% success rate. On the plaintiffs` side, many of these cases resulted in settlements well in the upper 6-digit range. Negligence claims have increased in medical practice in recent decades, with wrist injuries and their treatment accounting for a significant percentage of orthopedic surgery claims[5,6]. Some articles deal with malpractice in hand and wrist surgery, with most studies conducted in Europe.[6] However, there are no reports related to medical malpractice in wrist injuries and surgeries in Greece. A woman who was taken to the emergency room of a general hospital with a drink after an injury to her left wrist. She was examined by an orthopaedic surgeon and a general surgeon.
The wound was closed and oral antibiotics were prescribed. During reassessment 12 days later, a laceration of the ulnar nerve was diagnosed. As a result, she was referred to a specialized unit and her ulnar nerve was repaired. Despite treatment in a specialized centre, the patient was unable to make full use of her left hand after the operation. The patient filed a lawsuit in which she stated that she had missed the diagnosis of her injury. The proceedings were dropped in favour of the plaintiff and compensation of €3000 was set. The case was closed 7 years after the complaint was filed. Claims for negligence have increased in medical practice in recent decades.
A retrospective study by Ajwani et al[5] of 325 successful claims related to wrist and wrist injuries and surgery in England from 2002 to 2012 reported payments for hand injuries between £1,000 and £374077 and wrist injuries between £200 and £669471. In the same study, poor outcomes, nerve damage, unnecessary pain due to delayed diagnosis or treatment, additional procedures, and fractures were identified as the most common reasons for successful litigation[5]. A 9-year-old boy was taken by his parents to the emergency room of a general hospital in the city after injuring his left index, middle finger and ring finger. There he was examined by a general surgery assistant physician, who sutured the lacerations. Three days later, the boy was taken back to the emergency room for ischemic changes in his middle finger. Although they were admitted to the hospital, the parents wanted to see a pediatric surgeon at another hospital. A glove injury to the boy`s middle finger was diagnosed and a finger amputation was performed (the extent of the amputation was not mentioned in the complaint). The family filed a lawsuit reporting that the boy missed an injury diagnosis and was then mismanaged.
The case was finally dismissed 7 years later in favor of the accused. In Greece, hand and wrist injuries that are in the emergency room are first assessed by orthopedic, plastic or general surgeons, who usually review cases with a counselor. Residents examine the patient, request laboratory and image evaluations, and decide on treatment in “simple” cases, while complex cases that cannot be treated in hospital are referred to specialized hand surgery units. In district hospitals, initial assessment and management are carried out by an orthopaedic surgeon or general surgeon. However, treating hand injuries by non-specialists (residents or counsellors) carries the risk of a poor outcome with a subsequent increase in costs to the patient, employer and society, as noted by Kenesi and Masmejean in 2004[7]. Medical negligence lawsuits have shown an upward trend worldwide in recent decades, with hand and wrist liability placing a significant burden on orthopedic surgery lawsuits. Injuries to the hands and wrists are widespread and mainly affect young people and economically productive people. But even minor injuries can lead to long-term disability if not properly treated, as those affected can no longer work, socialize and perform routine daily activities. This is the first report of claims for medical negligence related to trauma to the hand and wrist in Greece. A missed diagnosis of a hand and wrist injury can result in long-term disability of a patient and was the primary reason for malpractice.
In the current study, a missed diagnosis resulted in partial or complete loss of a finger in half of the cases. In this study, we examined only claims related to trauma to the hand and wrist that were litigated. It cannot be construed as representative of all claims of malpractice in hand and wrist trauma. Currently, there is no official authority in Greece with which all claims of negligence can be lodged. As a result, we cannot estimate the total number of negligence claims for hand and wrist trauma filed between 2000 and 2019 or the number of out-of-court claims resolved (Table 11). Soft hand tissue injuries account for up to 82% of all hand injuries assessed in emergency departments. They can range from simple lacerations to more complex injuries requiring structural repair, with high-pressure injection injuries being “the most urgent of all hand emergencies.” High-pressure injection injuries, while uncommon with an estimated incidence of 1 in 600 injuries, can be disastrous for the patient if they are not immediately referred to a manual unit and treated appropriately. They have been associated with a high risk of amputation of the affected finger, ranging from 16% to 48%, as well as the risk of systemic intoxication if absent and appropriate treatment[15]. On the contrary, tendon injuries are common with an incidence of about 33.2 injuries per 100,000 person-years and accompany most penetrating hand injuries. Concomitant tendon injury may be present in 54.8% of small lacerations and 92.5% of deep wounds caused by a small laceration [16]. The objective of this study was to identify available data on medical malpractice in trauma and wrist surgeries in Greece, to define the reasons and assess the burden of successful litigation in Greece and to compare these data with international data on malpractice. In an emergency room, assessing hand injuries can be difficult.
Distraction injuries may also be present, patient adherence may be poor due to alcohol or substance use, the complexity of hand anatomy, and the involvement of residents or general surgeons with limited experience in hand surgery can all contribute to errors.[10] The two cases closed in favour of the plaintiff concerned a delay in the diagnosis of ulnar nerve injury, longus flexor pollicis and digital nerve injury. In the first case, compensation was established because there was no complete restoration of the nerve, although the reconstruction was carried out within the time allowed for nerve reconstruction. According to the decision, nerve reconstruction would be more likely to fully recover in the first days of the injury. In the second case, despite the delay in diagnosis, complete recovery of the nerve and tendon occurred. However, due to the delay in diagnosis, the applicant experienced pain and the inability to use his hand for 25 days until the structures were rebuilt, which was the justification for a judgment in favour of the applicant. Dr. John Knight is a world-renowned expert in the field of orthopedic hand and upper limb surgery. Dr. Knight has over 25 years of experience as an expert in his field and enjoys the highest credibility in legal circles due to his representation of the plaintiff and defence. Dr.
Knight has appeared on CNN, The Doctors TV, Good Morning America and other notable media outlets. He is proud of the 50/50 ratio of plaintiffs and defense attorneys across the board. Click here to view Dr. Knight`s resume. The patient sued claiming that the amputation was the result of a missed diagnosis and delayed referral to a specialized hand trauma unit. The case is still open and an expert opinion is required before a final decision is made. Professor Warwick`s medical law practice is based in Wessex. David is Chair of the Medico-Legal Committee of the British Orthopaedic Association. He has lectured and written extensively on medico-legal issues and is an expert on the full spectrum of hand and wrist diseases observed in forensic practice. Claims for personal injury and clinical negligence are reviewed for both plaintiff and defendant. Of the malpractice related to hand and upper limb surgery brought to court between 2000 and 2019, six cases were correlated with trauma to the hand and wrist. Lack of diagnosis, resulting in management failure and, in one case, late referral to a specialized entity, was the main reason for a claim.
A lower transaction was an additional ground for claim in one case. Lack of diagnosis was the main reason for malpractice. A better understanding of the factors that lead to successful claims will help surgeons improve their practice to minimize legal implications and litigation. Identify trauma and hand and wrist surgery claims and define the reasons for the success of the dispute. A better understanding of the factors leading to successful claims can lead to improved services for patients with hand trauma and help surgeons improve their practice to minimize legal impact and litigation.
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