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Review
. 2018 Jan 19;89(1-S):111-123.
doi: 10.23750/abm.v89i1-S.7015.

Traumatic fractures in adults: missed diagnosis on plain radiographs in the Emergency Department

Antonio Pinto  1 , Daniela Berritto, Anna Russo, Federica Riccitiello, Martina Caruso, Maria Paola Belfiore, Vito Roberto Papapietro, Marina Carotti, Fabio Pinto, Andrea Giovagnoni, Luigia Romano, Roberto Grassi
Affiliations
Review

Traumatic fractures in adults: missed diagnosis on plain radiographs in the Emergency Department

Antonio Pinto et al. Acta Biomed. .

Abstract

Radiography remains the imaging standard for fracture detection after trauma. The radiographic diagnosis of most fractures and dislocations poses little difficulty to radiologists: however, occasionally these injuries are quite subtle or even impossible to detect on radiographs. Missed diagnoses of fracture potentially have important consequences for patients, clinicians, and radiologists. Radiologists play a pivot role in the diagnostic assessment of the trauma patients: emergency radiologists who are more practiced at seeking out and discerning traumatic fractures can provide an invaluable service to their clinical colleagues by ensuring that patients do not endure delayed diagnoses. This is a narrative review article aims to highlight the spectrum of fractures in adults potentially missed on plain radiographs, the causes of error in diagnosis of fractures in the emergency setting and the key elements to reduce misdiagnosis of fractures.

Keywords: missed diagnosis, diagnostic error, fracture, emergency radiology, conventional radiography.

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Figures

Figure 1.
Figure 1.
Cross-table lateral (a) and open-mouth odontoid (b) radiographs of the cervical spine. Missed diagnosis of fracture of the C2 vertebral body revealed by the subsequent MDCT examination (c, coronal reconstruction, red arrow; d, sagittal reconstruction, red arrow)
Figure 2.
Figure 2.
Anteroposterior radiograph of the pelvis in elderly patient. The radiologist reported absence of fracture, recommending the need of a CT examination. Subsequent CT showed a right femoral neck fracture
Figure 3.
Figure 3.
Missed diagnosis of fracture of the lateral plateau of the knee on radiographs (a and b). Subsequent CT (c) showed the presence of the fracture
See this image and copyright information in PMC

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