Malpractice in the treatment of metacarpal fractures. Analysis of an expert opinion rendered by the commission on medical malpractice of the physicians' council in North Rhein

A large number of publications notwithstanding,there are no clear guideline s regarding the treatment of metacarpal fractures. Some authors believe tha t even severely dislocated fractures should not be surgically fixated. This paper analyzes the forensic problem on the basis of court rulings in G ermany. Seventeen evaluations of metacarpal fractures conducted by the comm ission on medical malpractice of the physicians' council in North Rhein wer e analyzed and common mistakes were listed. The average age of the eight male and nine female patients was 41.9 years. The fifth metacarpal bone (MB) was affected eight times, the fourth NIB fou r times,and the first MB twice. The second MB and third MB were affected on ce each. Surgery was performed in nine cases, while the conservative approach was ta ken eight times. An independent expert determined medical malpractice in 13 cases (76%). In 10 of these 13 cases,the symptoms the patients exhibited w ere linked to medical malpractice. In the 13 cases of medical malpractice t here were 5 cases with technically insufficient osteosynthesis, 4 cases of uncorrected dislocation, 2 false diagnoses, and 2 false immobilizations. An independent expert identified a link to the symptoms in three of the four cases of uncorrected dislocation. These were an anatomically nonreduced fra cture with joint involvement, a fracture with a dislocation of 50 degrees, and a fracture with rotation dislocation. Cases where fractures healed with severe dislocation or immobilization in a wrong position or for a too long a period are common but avoidable mistake s in the treatment of metacarpal fractures.