Medico-legal examination of patients with developmental dysplasia of hip treated surgically due to late diagnosis

Aim: Physicians assessing newborns with risk factors for developmental dysplasia of the hip (DDH) have responsibility for earlydiagnosis. Written records of the fulfillment of such responsibility is required in medico-legal terms. The present study aims toexamine the written records of the hospitals where patients with late-diagnosed DDH were born.Material and Methods: This retrospective study examined the records of the hospitals in which 53 DDH patients aged more than ninemonths were born. We investigated whether the requirements for the early diagnosis of these patients were recorded in written andinterviewed with the obstetricians, pediatricians and family physicians who followed these patients. They were asked about theirattitudes toward giving families informational documents about DDH and explaining protective measures verbally.Results: There was no written approved record that they have been informed about the disease in any institution and indicating thatthe responsibilities for the early diagnosis of these patients were fulfilled. The families were given informational documents in threeof five private hospitals and in one university hospital. All of physicians informed the families about the early DDH diagnosis and thethings to do, verbally.Conclusion: In case of late-diagnosed DDH, the society as well as the child and the child’s family get harmed socioeconomically.Therefore, it may pose a medico-legal problem. This risk increases more in countries where newborn screening policies are notadequately implemented. In conclusion, written documents taken from families about the early diagnosis of DDH will legally protectphysicians and health care organizations.

PDF

___

1. Shaw BA, Segal LS, Section on Orthopaedics. Evaluation and referral for developmental dysplasia of the hip in infants. Pediatrics 2016;138:3107.
2. Laborie LB, Markestad TJ, Davidsen H, et al. Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991-2006. Pediatr Radiol 2014;44:410-24.
3. Thallinger C, Pospischill R, Ganger R, et al. Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program. J Child Orthop 2014;8:3-10.
4. Synder M, Harcke HT, Domzalski M. Role of ultrasound in the diagnosis and management of developmental dysplasia of the hip: an international perspective. Orthop Clin North Am 2006;37:141-7.
5. Keller MS, Nijs EL. The role of radiographs and US in developmental dysplasia of the hip: how good are they? Pediatr Radiol 2009;39:211-5.
6. Rombouts JJ, Rombouts-Godin V. Delayed detection of hip dislocation: is the physician to blame? Pediatrie 1993;48:327-34.
7. McAbee GN, Donn SM, Mendelson RA, et al. Medical diagnoses commonly associated with pediatric malpractice lawsuits in the United States. Pediatrics 2008;122:1282-6.
8. Klisic PJ. Congenital dislocation of the hip-a misleading term: brief report. J Bone Joint Surg Br 1989;71:136.
9. Köse N, Ömeroğlu H, Dağlar B. Developmental hip dysplasia national early diagnosis and treatment program guide 2013. www.istanbulhalksagligi.gov.tr/ data/content/ Gelisimsel Kalca Displazisi.pdf.
10. Omeroğlu H, Caylak R, Inan U, et al. Ultrasonographic Graf type IIa hip needs more consideration in newborn girls. J Child Orthop 2013;7:95-98.
11. Graf R. The use of ultrasonography in developmental dysplasia of the hip. Acta Orthop Traumatol Turc 2007;41:6-13.
12. Von Kries R, Ihme N, Oberle D, et al. Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany. Lancet 2003;362:1883-7.
13. Songür M, Akel I, Karahan S, et al. Prevalence of untreated hip dislocation in Turkish children aged 6 months to 14 years. Acta Orthop Traumatol Turc 2011;45:215-20.
14. Gemalmaz A. Medical malpractice in family medicine. Turkiye Klinikleri J Fam Med-Special Topics 2014;5:56-62.
15. Pakiş I, Yaycı N, Karapirli M, et al. The role of legal autopsy in the investigation of death cases due to medical malpractice. Türkiye Klinikleri J Med Sci 2008;28:30-9.
16. Ertan A, Üzün İ, Öz H. Orthopedic surgery and anesthesia for forensic medicine. Turkiye Klinikleri J Anest Reanim-Special Topics 2014;7:68-74.
17. Jones D, Dezateux CA, Danielsson LG, et al. At the crossroads--neonatal detection of developmental dysplasia of the hip. J Bone Joint Surg Br 2000;82:160– 4.
18. Mace J, Paton RW. Neonatal clinical screening of the hip in the diagnosis of developmental dysplasia of the hip: a 15-year prospective longitudinal observational study. Bone Joint J 2015;97:265-9.
19. Büken E, Ornek Büken N, Büken B. Obstetric and gynecologic malpractice in Turkey: incidence, impact, causes and prevention. J Clin Forensic Med 2004;11:233-47.
20. TCK 5237. http://www.ceza-bb.adalet.gov.tr/ mevzuat/5237.htm.
21. Altun G, Yorulmaz AC. Physician responsibilty and medical malpractice after the legal regulations. Trakya Univ Tip Fak Derg 2010;27:7-12.
22. Tümer AR. Evaluation of orthopedic surgical litigations which was discussed in health council during 1996- 2000. Eklem Hastalik Cerrahisi 2003;14:182-87.
23. Pakiş I, Yayci N, Karapirli M, et al. Autopsy profiles of malpractice cases. J Forensic Leg Med 2009;16:7-10.