Analysis of Missed Fractures in Polytrauma Patients

Ki Chul Park; Hyun Uk Kim

doi:10.12671/jkfs.2014.27.4.281

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Park and Kim: Analysis of Missed Fractures in Polytrauma Patients

Original Article

Journal of the Korean Fracture Society 2014; 27(4): 281-286.

Published online: 20 October 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.4.281

Analysis of Missed Fractures in Polytrauma Patients

Ki Chul Park, M.D., Hyun Uk Kim, M.D.

Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea.

Address reprint requests to: Ki Chul Park, M.D. Department of Orthopedic Surgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Korea. Tel: 82-31-560-2318, Fax: 82-31-557-8781, kcpark@hanyang.ac.kr

Received 9 May 2014 Revised 23 June 2014 Accepted 30 July 2014

(open-access):

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 determine the frequency of missed fractures in severe multiple trauma patients and to analyze any differences in treatment plan, after whole body bone scan.

Materials and Methods

From September 2012 to December 2013, 49 patients were confirmed to have multiple trauma with an injury severity score (ISS) of 16 or higher. Whole body bone scan was performed at an average of 15.7 days (7-25) after injury. Missed fractures were diagnosed according to physical examination and additional radiologic reports. Locations and patterns of missed fractures were analyzed. We evaluated any differences in treatment plan after the diagnosis of missed fractures.

Results

Missed fractures were diagnosed in 14 patients (16 cases) on the whole body bone scan. The most frequent location was the knee (three cases), followed by rib, clavicle, carpal bone, and foot. Seven cases were occult fractures, five cases were undisplaced fractures and four cases were displaced fractures. Conservative treatment was administered in 15 patients and surgery was necessary in one patient.

Conclusion

Delayed or missed diagnosis of fractures occurred frequently in patients of multiple trauma with a high ISS. Whole body bone scan appears to be effective in finding missed fractures in the whole body. Definitive assessment should be supplemented after initial trauma care in order to reduce the rate of missed fractures.

Keywords: Multiple trauma, Whole body bone scan

Figures and Tables

Fig. 1

A 41-year-old man had a left forearm bone fracture, left clavicle fracture, right scapula fracture, and multiple rib fractures due to a motorcycle accident. Bone scan was checked at two weeks after the accident. (A) Focal hot uptake was observed at the right scaphoid area. (B) A radiograph of the right wrist was checked and showed obvious scaphoid fracture. (C) Scaphoid fracture was treated with open reduction and internal fixation.

Table 1

Patient Demographics

Notes

Financial support: None.

Conflict of interest: None.

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