Avoidable injuries in pediatric hand fractures: a 30-year review of compensation claims in Finland.

Background and purpose: We aimed to evaluate the risk, causes, and compensation outcomes of avoidable injuries in pediatric hand fractures.

Methods:  All compensation claims submitted to the Finnish Patient Insurance Centre (PIC) for pediatric hand fracture treatment (< 16 years) in Finland from 1990 to 2019 were reviewed. Data collected included fracture location, compensation rate and reasons, treatment setting, and treating professional specialty. PIC decisions were reassessed. Census population (3.0 x 107) was calculated from national registers, and hand fracture incidence estimated (350/105).

Results:  Of 101 claims, 71 were compensated as avoidable injuries, encompassing 72 complications by 74 professionals. Compensated claims were most common for finger fractures (43/65), followed by metacarpal (15/20) and scaphoid fractures (14/17). 1 claim involved both a finger and metacarpal fracture, and in 3 claims faults were made by 2 separate professionals. Most injuries occurred in healthcare centers, with general practitioners responsible for 37/74 avoidable injuries. Diagnostic delays led to most compensation (36 cases: 23 lacked initial radiographs, 12 missed fractures on radiographs). Compensation for permanent disability (5-10%) was granted in 8 cases (4 finger and 4 scaphoid fractures) and for cosmetic disability in 21/43 finger fracture cases. PIC decisions were deemed correct in 98/101 cases, with a calculated risk of compensated avoidable injury at 0.1%.

Conclusion:  The risk of avoidable injuries with permanent sequelae in pediatric hand fractures in Finland is low. Use of diagnostic radiographs is advised in children with hand injuries, especially if scaphoid fractures are suspected.