162.
Fractures of the knee in children - what can go wrong?
Veronica Leeberg, Stig Sonne-Holm, Jens Krogh Christoffersen, Christian
Wong
Department of Orthopaedic Surgery Hvidovre University Hospital;
Department of Orthopaedic Surgery, Hvidovre University Hospital; , The
Patient Insurance Association; Department of Orthopaedic Surgery, Hvidovre
University Hospital
Background:
Intraarticular knee fractures (KF) in children are rare
(3:100.000
children/year). The Danish Patient Insurance Association (DPIA)
receives complaints from patients who believe they've sustained a damage
from their treatment. We used relevant cases to identify causality and co-
factors contributing to these apparent malpractices.
Purpose / Aim of Study:
A partial root core analysis was performed
identifying factors contributing to apparent malpractices to proximal tibia
fractures in children 15 years of age or younger from complaints in DPIA.
Materials and Methods:
A review of medical journals, the in-house database
and journals of DPIA. The selected cohort of cases of KF were retrieved by
sweeping the DPIA database for the diagnose codes DS821 and DS821A-D.
Findings / Results:
13
cases of KF were identified with a majority of
proximal tibial fractures and from high-energy traumas. The main complaint
was missed diagnosis; KF interpreted as soft tissue injuries with no
radiological examination primarily (6 cases), eminentia fractures were the
main culprit, damage to the popliteal artery caused by a medial condyl fracture
the most serious. All cases missed by junior doctors. Secondary complaints
were problems with the bandaging time (ranging from 1-6 weeks) and type (3
cases), dissatisfied with correct treatment (3 cases) and insufficient operative
procedure or complications (3 cases), where infection after internal fixation
was the worst. Eight of the complaints were acknowledged by the DPIA, 6
receiving financial compensation ranging from 72.000 to 520.000 kr. Five out
of 6 cases of missed diagnosis were acknowledged.
Conclusions:
This study indicates that recognizing the degree of injury to the
knee in children, which would lead to an x-ray examination, is the key
parameter to prevent missed diagnoses and delayed and potentially more
difficult surgery.
