Malpractice and Compensation Claims After Hip Fracture care: A Systematic Review of Cross-Jurisdiction Trends and Predictors of Plaintiff Success

Division

North Texas

Hospital

Medical City Denton

Document Type

Manuscript

Publication Date

4-22-2026

Keywords

compensation and redress, diagnostic error, hip fracture, legal liability, medical malpractice

Disciplines

Bioethics and Medical Ethics | Medicine and Health Sciences | Orthopedics | Surgical Procedures, Operative

Abstract

BACKGROUND: Hip fracture care requires timely diagnosis, expedited surgery, and high-risk inpatient management. Failures along this pathway can result in patient harm and malpractice exposure. This review synthesized cross-jurisdiction malpractice trends and inflation-adjusted liability payments associated with adult hip fracture care.

METHODS: A PRISMA-guided systematic review was conducted. PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched from January 2000 through January 2026. Eligible studies reported malpractice claims and outcomes specific to adult hip fracture care. Monetary values were converted to 2026 United States dollars (USD) using the Consumer Price Index. British pound values were converted using 1 GBP = 1.30 USD. Results were synthesized descriptively owing to heterogeneity in medicolegal frameworks.

RESULTS: Six studies met the inclusion criteria, representing 1192 hip fracture-related claims from the United States (U.S.), United Kingdom (U.K.), and Norway. Hip fractures accounted for 7%-17% of fracture-related claims in tort-based systems. Among 445 National Health Service Litigation Authority (NHSLA) claims, plaintiff success rates ranged from 56% to 69%, compared with 31% in 80 U.S. jury-based cases. Diagnostic delay or missed diagnosis was the most frequent allegation (28%-40%) and the only independent predictor of plaintiff success in U.S. data (odds ratio, 12.57). U.K. datasets reported total indemnities exceeding $25 million (2026 USD), with pressure injuries demonstrating the highest mean payouts. In Norway's no-fault system, 616 claims were filed following 90,601 hip fracture surgeries (0.7% claim rate), with 36% accepted, most commonly for hospital-acquired infection.

CONCLUSIONS: Medicolegal risk after hip fracture care clusters around process-driven failure points, particularly diagnostic delay and ward-based care breakdowns, rather than isolated technical errors. Missed diagnosis was the only independent predictor of plaintiff success in the U.S.

DATA: Findings suggest that pathway-level interventions targeting diagnostic accuracy, operative timeliness, and inpatient surveillance may reduce both patient harm and medicolegal exposure.

Publisher or Conference

Injury

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