Misdiagnosed and maltreated scaphoid fractures – costly both for society and patients: A review of filed claims to the Swedish National Patient Insurance Company 2011–2018

Andersson, Jonny; Gustafson, Pelle; Kopylov, Philippe

doi:10.1530/eor-21-0108

Cited by 4 publications

(11 citation statements)

References 23 publications

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“…These are only the costs of hardware removal and sick leave; they do not include the time saved in the operation theater at the initial operation and other costs, such as those of additional visits and medication. In a very recent publication, Andersson et al [15] described that the frequency of settled claims of scaphoid fractures was 20% higher than for general complaints [15]. Furthermore, they found that 56% of the claims were due to delayed diagnosis and 41% were due to misdiagnosis [15].…”

Section: Discussionmentioning

confidence: 99%

“…C The skin incision was pulled proximally with a narrow-wound hook and, at the same time, the wrist was bent so that the protruding material of the cortical bone screw could be sawn off just above the bone surface in a subsequent step Sailer et al Journal of Orthopaedics and Traumatology (2023) 24:6 chevron osteotomy, and by Hanslik-Schnabel et al [12] when using it for the correction of hallux rigidus with and without deformities. Scaphoid fractures account for 50-90% of all carpal fractures in young active patients [13][14][15]. Approximately 10% [13,[16][17][18] of all scaphoid fractures progress to nonunion, dependent on the fracture location, fracture displacement, instability and time to treatment [17].…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 10% [13,[16][17][18] of all scaphoid fractures progress to nonunion, dependent on the fracture location, fracture displacement, instability and time to treatment [17]. Delayed diagnosis and consequently delayed treatment is an avoidable complication and often leads to nonunion and additional surgeries [15,19]. The accepted standard treatment of scaphoid nonunion is non-vascularized grafting with internal fixation [19,20].…”

Section: Introductionmentioning

confidence: 99%

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Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study

Sailer¹,

Lechner²,

Floßmann

et al. 2023

J Orthop Traumatol

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Background Allograft bone screws are rarely described for the fixation of the scaphoid. When fresh fractures are treated, metal screws are mainly used; when pseudarthrosis is the indication, plates in combination with vascularized or non-vascularized bone grafts are mainly used. The necessity of metallic screw removal is under debate, but it is mandatory for plates because of movement restrictions due to the plate. The use of biomaterials in scaphoid fracture fixation was described as leading to union rates of between 64 and 100%. Brcic showed the incorporation of an allogeneic cortical bone screw at 10 weeks postoperative, along with revascularization and stable osteosynthesis with primary bone healing, without any signs of immunological rejection. The purpose of this retrospective study was to explore the results obtained using an allogenic cortical bone screw (Shark Screw®) in patients with fresh scaphoid fracture fixation and pseudarthroses with respect to union rates and time to union. Patients and methods We retrospectively analyzed 75 patients: 31 with fresh fractures and 44 pseudarthrosis patients. The Shark Screw® was used for the fixation of the scaphoid in the fresh-fracture and pseudarthrosis patients. We evaluated the union rate, complication rate and time to union. Results Using the human allogeneic cortical bone screw for scaphoid fracture fixation led to a high union rate (94–96%). There were two nonunions in the fresh fracture group and two nonunions in the pseudarthrosis group. The complication rate was 1.3% (1 patient). Median time to union was 16, 18 and 29 weeks for the fresh-fracture, pseudarthrosis and delayed-union patients, respectively. The treatment of fresh scaphoid fractures and pseudarthroses showed similar union rates to those described in the literature, uses a shorter and less invasive surgical method with no need for hardware removal, and has a low complication rate. Conclusion Using the human allogenic cortical bone screw (Shark Screw®) led to similar union rates in fresh fractures—but better union rates in pseudarthrosis patients—compared to those presented in the literature for other scaphoid fracture fixation techniques, and it enabled a short and low-invasive procedure without any donor site morbidity and without the necessity to remove the hardware in a second surgery. The pseudarthrosis patient group showed a particularly strong benefit from this new procedure. The physiological bone metabolism remodels the cortical bone screw without scars. Level of evidence: III: retrospective cohort study, therapeutic investigation of a treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study

Sailer¹,

Lechner²,

Floßmann

et al. 2023

J Orthop Traumatol

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“…In this study from Lund (Sweden) , all claims relating to scaphoid fractures over a seven-year period from 2011 to 2018 were analyzed to look for complications and the associated costs to society. 6 A total of 128 claims were identified, 78 (61%) of which were judged as avoidable by the claim registry and the expert physician. Overall, 72 of these were filed because of delayed diagnosis and consequently delayed treatment.…”

Section: Misdiagnosed and Maltreated Scaphoid Fractures - Costly Both...mentioning

confidence: 99%

“…In Sweden, all claims filed to the Swedish National Patient Insurance Company (LÖF) are registered in a database. In this study from Lund (Sweden), all claims relating to scaphoid fractures over a seven-year period from 2011 to 2018 were analyzed to look for complications and the associated costs to society 6. A total of 128 claims were identified, 78 (61%) of which were judged as avoidable by the claim registry and the expert physician.…”

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confidence: 99%

Research

2022

Bone & Joint 360

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Clinical and Socioeconomic Effects of Misdiagnosed Wrist Ligament Injuries

Rosvall,

Hagert,

Gustafson

et al. 2024

J Wrist Surg

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Purpose Misdiagnosed and maltreated wrist ligament injuries (scapholunate [SL], lunotriquetral, and triangular fibrocartilage complex [TFCC]) filed to the Swedish National Patient Insurance Company (LÖF [“regionernas ömsesidiga försäkringsbolag”]) 2011 to 2018 were analyzed in terms of complications and costs for society. Methods All filed claims are database registered. The database was assessed in June 2019 through injury International Classification of Diseases 10th Revision-SWE diagnoses. Demographics, reasons for avoidance, type of complication, and costs were assessed. Trend analysis was also used to compare the numbers of filed claims of wrist ligament injuries and total injuries. Results The mean age of the 231 extracted patients was 38 years. Females represented 57%. Ninety-eight (42%) of the claims were judged as avoidable, in accordance with the 40% approved patient injuries of all notified injuries during the same time period. Isolated injuries to the TFCC and SL ligament were the most common (n = 185, 80%). One to seven secondary surgical procedures/patient were needed to treat the condition. Sixty-nine (30%) of the 231 patients had medical invalidity due to the avoidable complication(s). Disability was more severe if more than one surgical procedure was needed. There was a significant trend toward decreasing numbers of filed claims for wrist ligament injuries (p = 0.002) over time, in contrast to the total number of filed claims to LÖF, which has increased by an average of 6% annually for a cumulative increase of 60% from 2011 to 2018. Interpretation The total cost for misdiagnosed and mistreated wrist ligament injuries in Sweden from 2011 to 2018 was €2,203,467, and costly for both the patients and society at large. Level of Evidence Level III, therapeutic.

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Misdiagnosed and maltreated scaphoid fractures – costly both for society and patients: A review of filed claims to the Swedish National Patient Insurance Company 2011–2018

Cited by 4 publications

References 23 publications

Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study

Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study

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Clinical and Socioeconomic Effects of Misdiagnosed Wrist Ligament Injuries

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