A Comparative Risk Analysis of Malpractice Claims in Hand Surgeons Trained in Plastic and Orthopedic Surgery.

Background: Despite the ability of both plastic surgeons and orthopedic surgeons to treat hand and wrist injuries, significant differences exist in clinical practice between hand surgeons with differing residency training backgrounds. This study sought to investigate the influence of residency training on medicolegal exposure among hand surgeons trained in orthopedic and plastic and reconstructive surgery (PRS). Methods: The Westlaw database was queried for all jury verdicts and settlements related to hand and wrist surgery and filed directly against an orthopedic or PRS hand surgeon. Extracted data included patient and defendant demographics, alleged negligence, damages, and payouts. Results: A total of 66 cases out of 3933 were included. A defendant verdict was reached in 55 (83.3%) cases. The average monetary award was $2.1 million. The most common preceding treatment was fracture repair (n = 20, 30.3%) and carpal tunnel release (n = 13, 19.7%). Out of 66 cases, 52 (78.8%) were levied against orthopedic-trained hand surgeons. Therapeutic delay (P = 0.0068) or patient death (P = 0.0242) were predictive factors of a plaintiff verdict. PRS surgeons faced greater risks of litigation in cases following soft tissue repair, therapeutic delay, or negligence requiring an amputation. Conversely, orthopedic surgeons were more likely to face litigation following fracture repair. Conclusions: Although specialty training of hand surgeons alone does not considerably influence the risk of facing medical malpractice litigation, differences in medicolegal trends within hand surgery reflect key differences in prevailing residency training emphases, clinical exposure, and geographic practice distribution between orthopedic- and PRS-trained hand surgeons.