As of 2010, the American Academy of Orthopaedic Surgeons (AAOS) has licensed 25,462 orthopedic surgeons across the nation trained to manage patient issues stemming from the musculoskeletal system. The AAOS is responsible for maintaining the standards of professionalism which establish the minimum standards of acceptable conduct for orthopedic surgeons. Orthopedics is a specialized area of medicine, and like other specialties, this sphere of medicine is not immune to medical error and negligence. Due to the nature of this field of medicine, misdiagnosis concerning orthopedics generally occurs when a family physician attempting to treat a patient and is unfamiliar with orthopedic ailments.
Orthopedic Misdiagnosis and Error
Typically, a misdiagnosis is caused by a physician that fails to recommend X-rays or orders such a test only to misinterpret the results. Either scenario can lead to an undiagnosed skeletal fracture or malfunction, which can result in long-term damage to the patient. If an ailment is not properly diagnosed, a minor injury such as a hairline fracture can evolve into a severe medical complication. For example, if a joint fracture is not diagnosed or properly treated the fracture may lead to permanent damage, which may require joint replacement surgery. Physicians who do not fully diagnosis and treat a patient with an orthopedic issue can cause the patient to lose functionality within a body part, cause life-altering deformities, and permanently damage nerve endings.
Additional examples of medical errors likely to occur in orthopedic cases include:
- Anterior cruciate ligament (ACL) tear is often misdiagnosed as an injury to knee ligaments.
- 25% of achilles tendon ruptures are not initially diagnosed or caught by physicians.
- A delayed diagnosis of scaphoid fractures may result in premature wrist arthrosis.
- Slipped capital femoral epiphysis typically results in little to no pain, thus physicians commonly misdiagnosis its symptoms.
- If not diagnosed and treated, femoral neck stress fractures could cause a re-fracture or avascular necrosis.
In 2010, orthopedic surgery ranked fifth in medical specialties for both the number of lawsuits filed and the number of claims that result in financial payoff for plaintiffs. The top five allegations made by patients in this specialty include:
- 52% improper performance during surgery
- 14% error in diagnosis
- 8% failure to recognize complications during treatment
- 6% failure to supervise or monitor a case
- 20% additional allegations
The AAOS has noted that physicians specializing in this field of medicine can implement certain steps into their practice as a means of limiting their liability. The AAOS recognizes that those specializing in orthopedics should:
- Invest time in patient communication
- Document discussions of risks and benefits of treatments and therapies
- Avoid altering records
- Write legibly
- Update documents and post-operative notations on a regular basis
- Read a chart in its entirety, including nurses’ notes
- Be aware of and comply with professional standards and regulations
According to a survey conducted by members of the Department of Orthopaedic Surgery at St. Luke’s Medical Center in Cleveland, Ohio, it was determined that lumbar spine was among the most common anatomic area associated with medical malpractice cases. Contributing factors included physicians who appeared to be rushed or uninterested, as well as poor physician-patient relationships. The study postulated that an increase in both educational and professional programs could assist in public awareness of orthopedic malpractice risks as well as identify problems which could be otherwise prevented.