Out of court settlement of malpractice claims relating to the treatment of fractures in children: experience of the arbitration board of the North German Medical Associations.

BACKGROUND The medical peer-review committees and arbitration boards of the Medical Associations of the individual German federal states assess claims for damages arising from alleged medical malpractice. METHODS 189 panel proceedings concerning alleged malpractice in the treatment of fractures in children were evaluated on the basis of the available documentation and decisions. The proceedings were evaluated with respect to the involved medical specialties and treatment facilities, the types of fracture and particular allegations in each case, the actual malpractice found to have been committed (if any), and the harm resulting from malpractice. The cases were derived from the nine German states for which the North German arbitration board is responsible. RESULTS An actual malpractice was found to have been committed in 64% of cases, or about twice as frequently as the average rate among all cases going before an arbitration board in Germany. Most of the medical errors involved inaccurate diagnostic evaluation, misinterpretation of radiological findings, inappropriate treatment for the particular type of fracture involved (conservative rather than operative, or vice versa), or inadequate follow-up of the fracture (or none at all). The highest rate of a positive finding of malpractice involved fractures in the elbow region (77%). A mild or moderate degree of permanent injury due to malpractice was found in 37 cases (31%) and severe permanent injury in 16 cases (13%). CONCLUSIONS The appropriate treatment of fractures in children requires experience in clinical examination as well as knowledge of radiological anatomy and of the problematic fracture types and localizations. The results reported here should raise consciousness of the possibilities for medical error and thus help prevent future instances of malpractice.