Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2014 Apr;27(2):113-119. Korean.
    Published online Apr 18, 2014.
    https://doi.org/10.12671/jkfs.2014.27.2.113
    Copyright © 2014 The Korean Fracture Society. All rights reserved.
    Original Article

    Missed Fractures in Severely Injured Patients

    Hee-Gon Park, M.D., Jae-Sung Yoo, M.D., and Hyung-Suk Yi, M.D.
      • Department of Orthopedic Surgery, Dankook University Hospital, Dankook University Medical College, Cheonan, Korea.
    • Address reprint requests to: Jae-Sung Yoo, M.D. Department of Orthopedic Surgery, Dankook University Hospital, 201 Manghyang-ro, Dongnam-gu, Cheonan 330-715, Korea. Tel: 82-41-550-6579, Fax: 82-41-556-3238, Email: idbabe@naver.com
    Received October 30, 2013; Revised December 02, 2013; Accepted December 18, 2013.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    The purpose of this study is to analyze anatomic distributions, diagnostic methods, and prognosis of missed fractures in patients with severe injury.

    Materials and Methods

    A review of single-institutional medical records between January 2001 and May 2012 identified 58 patients with 62 delayed diagnoses of fractures among 4,643 severely injured patients older than 20 years with Injury Severity Scores higher than 16. We evaluated combined injuries, location of fractures, diagnostic methods, and reasons for missed diagnosis at initial exam.

    Results

    Among 62 missed fractures, there were eight cases of spine fracture, 10 cases of peri-shoulder joint fracture, eight cases of upper extremity fracture, 10 cases of pelvis of acetabulum fracture, and 26 cases of lower extremity fracture. Head injury was the most common concomitant injury (23 cases). Initially missed fractures were most commonly discovered by official reading by radiologists. The most common reasons for misdiagnosis were the use of improper radiologic study and missed-reading of proper radiologic studies.

    Conclusion

    In order to prevent misdiagnosis of fractures in patients with severe injury, meticulous physical examination with suspicion of fractures should come first. In addition, obtaining proper radiologic study and thorough evaluation of radiologic images are important to decreasing the rates of missed fracture diagnoses. In addition, thorough surveillance for ipsilateral fractures is important in extremities with identified fractures.

    Keywords
    Severely injured patient; Fracture; Missed fracture

    Figures

    Fig. 1
    (A) Antero-posterior and lateral radiographs of the knee in a 42-year-old man show no definite fracture lines. (B) Sagittal and coronal T2-weighted magnetic resonance images show a tibial plateau fracture.

    Fig. 2
    (A) Anter-posterior and lateral radiographs of the femur in a 34 year-old man show a femoral shaft fracture. (B) Antero-posterior and lateral radiographs of the femur after the operation show intramedullary nailing fixation. (C) Antero-posterior radiograph of the hip after the operation shows a neglected femoral neck fracture. (D) Antero-posterior radiograph of the hip after the secondary operation shows multiple screw fixation.

    Tables

    Table 1
    Fractures Missed in 56 of 4,643 Polytrauma Patients

    Table 2
    How the Diagnosis Was Made

    Table 3
    Reasons for Missing the Diagnosis

    Table 4
    Patients with More than One Lesion in the Same Extremity

    Table 5
    Delay from Accident to the Diagnosis of an Injury

    Notes

    Financial support: None.

    Conflict of interest: None.

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    MeSH Terms
    Acetabulum
    Craniocerebral Trauma
    Delayed Diagnosis
    Diagnosis
    Diagnostic Errors
    Extremities
    Humans
    Injury Severity Score
    Joints
    Lower Extremity
    Medical Records
    Pelvis
    Physical Examination
    Prognosis
    Spine
    Upper Extremity
    Metrics
    Share
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