Litigation in Hand and Wrist Related Injuries and Surgery.

BACKGROUND: We aimed to evaluate the burden of successful litigation relating to wrist and hand injuries and surgery. MATERIAL AND METHODS: A retrospective review was conducted using the English national litigation data-base, National Health Service Litigation Authority database. RESULTS: A total of 325 successful claims were analysed from 2002-2012. The total cost of successful claims was £19.5 million. This comprised £10.9 million in damages, with £8.4 million in legal costs (23% in NHS legal costs, the remainder being claimant costs). The mean cost of settling a claim for wrist and hand injuries respectively was £60,325 (range £200 - £669,471) and £58,926 (range £1000-£ 374,077). The commonest cause of claim for both wrist and hand injuries was poor outcome. The average cost for wrist and hand injury respectively was £52,825 and £63,926. CONCLUSIONS: 1. The complexity of resolving these cases is reflected in the associated legal costs, which represent a significant proportion of payouts. 2. This paper helps improve our understanding of factors instigating successful legal proceedings to aid identification of areas where practice and training can be improved.

Computer assisted versus conventional total knee replacement: a comparison of tourniquet time, blood loss and length of stay.

UNLABELLED: AIMS AND INTRODUCTION: The aim of this study was to assess whether navigated total knee arthroplasty (TKA) reduces peri-operative blood loss and post-operative length of stay when compared to conventional total knee arthroplasty techniques. PATIENTS AND METHODS: A retrospective case-note review of 143 patients undergoing primary elective total knee arthroplasty was carried out. Two surgeons in this institution perform conventional knee arthroplasty using intramedullary alignment with another two surgeons using the computer assisted technique. Blood losses were calculated using the Meunier et al. (2008) [23] method for calculation of peri-operative blood loss. This is based on changes in peri-operative blood indices compared to the patient's theoretical total blood volume which is calculated using the patient's pre-operative height and weight. Tourniquet time and post-operative length of stay for the two techniques of arthroplasty were also recorded. RESULTS: Sixty eight patients underwent conventional TKA and 75 patients had navigated TKA's performed. This data showed no significant difference in blood loss (p=0.56) or post-operative length of stay (p=0.36). A significant difference in tourniquet time between the two techniques was demonstrated (p=0.01). CONCLUSION: In this study there was no significant reduction in post-operative length of stay and peri-operative blood loss when using computer-assisted techniques. There was an increase in tourniquet time with the computer-assisted technique that may have implications upon work productivity for primary cemented knee arthroplasty.