Wrong-Bone Excision in Hand Surgery

Abstract

Background: The incidence of wrong-bone excision in hand surgery is not known. The wrist offers a unique challenge in that a single surgical incision yields access to multiple potential surgical sites, thus rendering site marking less effective. Mistaken identification of structures in the wrist is a real and potentially troublesome phenomenon. This study is designed to evaluate the occurrence of wrong-bone excision and to identify any risk factors and preventative measures that may help to prevent this complication in the future. Methods: We designed an anonymous online survey to determine the occurrence, risk factors, medicolegal outcomes, and preventative measures of wrong-bone excision. We distributed the survey to 777 hand surgeons via email. Results: Ninety-nine surgeons responded to our survey. Twenty-three respondents had participated in an excision of the incorrect bone in the wrist. The most common error was partial or complete excision of the scaphoid during a planned excision of the trapezium. Respondents indicated that inadequate visualization, inadequate localization, and teaching of a resident or fellow contributed to the error. There was only 1 case of legal action. Conclusions: The results of our survey indicate that there exists a non-zero incidence of wrong-bone excision in hand surgery. The most common mistake is incorrect excision of the scaphoid during a planned trapeziectomy. Most surgeons feel that their patients were pleased with their outcome despite this complication, and legal action is rare. Deliberate identification of known landmarks was identified as the most useful strategy in preventing wrong-bone excision.