Clinical and Socioeconomic Effects of Misdiagnosed Wrist Ligament Injuries

Abstract

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.