Learning objectives
To describe the implications of missed foot fractures in the Emergency Department.
To understand the diagnostic benefit of further imaging modalities including CT and MRI imaging.
To understand the confounding factors behind errors in image interpreatation.
Background
The interpretation and reporting of acute foot fractures on plain radiographs is a challenging task.
Reporting errors can lead to delayed treatment and poorer patient outcomes.
The patient may be a suitable candidate for an open reduction and internal fixation procedure under the orthopaedic surgical team (Fig.1).
However,
with a missed fracture the bone healing process may be too far along andthe patient may no longer be deemed a suitable candidate for surgery.
This can effect daily living for the patient and lead to chronic...
Findings and procedure details
Methodology
A retrospective clinical audit was performedanalysinginitial foot x-ray reports on patients presenting to the Ulster Hospital,
Emergency Department.
The reports were created using the RIS SECTRA system by radiologists and reporting radiographers.
The reports wereanalysedfrom between December 2016 and March 2017.
When analysing the reports we assessed;
1.
If a fracture was present on the initial x-ray?
2.
If no fracture identified,
where there was strong clinical concern,
was appropriate follow up imaging recommended?
3.
If no fracture identified,
was there any fracture identified...
Conclusion
There are a number of confounding factors responsible for errors in image interpretation.
The image quality,
number of views available and lack of previous imaging can be important factors.The clinical input is also an important factor in terms of the quantity and quality of clinical information provided [1-4].
Foot fractures are common fractures missed in Emergency Radiology.
It is important to accept that film radiography can be equivocal and that further imaging may be required with a relatively low thresholdfor CT imaging if the patient...
References
Spectrum of diagnostic errors in radiology J Radiol.
2010 Oct 28; 2(10): 377–383.
Radiographically Occult and Subtle Fractures: A Pictorial Review.
Jarraya et al.
Res Pract; 2013: 370169.
Errors in imaging patients in the emergency setting.
Antonio Pinto,
J Radiol.
May 2016; 89(1061): 20150914.
Systematic analysis of missed extremity fractures in emergency radiology.
Wei et al.
Radiol.
2006 Sep;47(7):710-7.