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Risk management in trauma and orthopaedics.

An analysis of 100 British cases of alleged medical negligence in the field of orthopaedics and trauma surgery shows that failure to take or to interpret an X-ray was the essence of the largest group of cases. Immediate settlement was advised in 56 cases, the majority of which involved errors made by junior hospital doctors and would have been avoided had a consultant been involved. Faults made in accident and emergency departments related largely to failure to refer the patient to other hospital departments for further management and follow up. Both diagnostic and operative errors were represented in the group. A retrospective study such as this provides some important lessons, relating particularly to situations justifying the use of antibiotics, the need for selective referral, the taking and interpretation of X-rays, and above all to the value of establishing rules to ensure sufficient involvement of consultants.