The litigation cost of negligent scaphoid fracture management.

The aims of the study were to quantify the litigation cost of scaphoid mismanagement, identify the main reasons why patients sought compensation and hence provide suggestions for reducing litigation. Data were obtained from the National Health Service Litigation Authority. All orthopaedic-related litigation between 1995 and 2010 in the UK was reviewed. Litigation specifically against mismanagement of scaphoid fractures were identified and grouped according to the plaintiff's complaint. Exclusions were all unsettled claims. There were 85 closed cases of scaphoid fracture mismanagement over 15 years. Reasons for litigation were as follows: seven failures in interpreting radiographs, 57 missed fractures, four fractures not immobilized, nine discharged too early, five delayed operations and three inappropriate surgeries. The mean cost was &OV0556;41 680 per case (range &OV0556;0-&OV0556;206 789), and a cumulative cost of &OV0556;3 542 855. The majority of litigation may relate to a lack of follow-up and may demonstrate a failure of protocol-driven reassessment. Secondary surveys following major trauma are also highly relevant.