DENVER-A hand-surgery mishap may lead to litigation if the surgeon fails to hold the patient’s other hand.
In a 10-year study of 107 iatrogenic hand-nerve lacerations, mainly caused by orthopedic or plastic surgeons, 85 were blamed by the surgeons on aberrant anatomy. But that excuse proved illusory for 59 during reparative surgery, says a Philadelphia Hand Center team.
Other reasons given for the iatrogenic injuries were inadvertent patient movement, faulty equipment, “the knife slipped,” and “nerves running funny.”
Treating surgeons recognized 30 of the injuries during the original operation and were able to repair 24 of the lacerated nerves. Six others were referred to a hand surgeon.
Sixty-three of the 107 patients sued, Dr. Lee Osterman told the American Society for Surgery of the Hand meeting here. Litigation was more likely if there was no preop discussion, if surgeons were “poor hand-holders,” if they denied it happened, or if the procedure had been expected to be simple. The treating surgeon diagnosed 61 injuries postop, but 19 were never recognized by the original surgeon.
Every hand is different, notes the Philadelphia team, and about 20% don’t follow the textbook wiring chart. Lacerated nerves included the median, digital, ulnar, and radial, plus those in the brachial plexus.
Carpal-tunnel release, Dupuytren’s, volar ganglionectomy, and elbow and shoulder arthroscopy were among the most common procedures. So far, 34 suits have been settled, and surgeons won seven of 12 cases that went to court. -Judith Groch
DENVER-A hand-surgery mishap may lead to litigation if the surgeon fails to hold the patient’s other hand.
