Avoidable injuries in the treatment of developmental dysplasia of the hip: a 34-year retrospective analysis of compensation claims in Finland

Aims: This study aimed to evaluate all compensation claims related to the management of developmental dysplasia of the hip (DDH) in Finland between 1 January 1987 and 31 December 2020, with a particular focus on cases compensated as avoidable treatment injuries. A secondary aim was to identify the underlying causes of these adverse events to support the prevention of similar incidents in the future. Methods: We conducted a retrospective review of all compensation claims and decisions made by the Finnish Patient Insurance Centre (PIC) concerning management of DDH over a 34-year study period. We used data from the national care register (HILMO) to extrapolate the number of children aged under 15 years who received treatment for DDH in Finland between 1 January 1987 and 31 December 2020. We then assessed the nationwide risk of compensated treatment injuries of DDH. Results: During the study period, 55 patients filed compensation claims related to the management of DDH, of whom 43 received compensation as an avoidable treatment injury, with a calculated incidence of 2.4 per 1,000 DDH patients (95% CI 1.7 to 3.2). Delayed diagnosis was the most common reason for compensation (35/43): 23 cases were missed in hospitals; 21 in child welfare clinics; and nine were missed in both a hospital and a child welfare clinic. The most common reason for delayed diagnosis (20/35) was the failure to recognize typical clinical findings associated with DDH. Conclusion: The number of compensated treatment injuries in the management of DDH was low in Finland, with most cases resulting from delayed diagnosis.