Type:
Educational Exhibit
Keywords:
Trauma, Education and training, Medico-legal issues, Education, Audit and standards, Digital radiography, CT, Conventional radiography, Musculoskeletal bone, Emergency, Acute
Authors:
C. McLoughlin1, N. Pathirana2; 1Belfast/UK, 2Dundonald/UK
DOI:
10.26044/ecr2019/C-0357
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.
Fig. 1: A transverse dorsal navicular body fracture with subsequent open reduction and internal fixation.
References: 2018 Lineage Medical, Inc. Orthobullets.com
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 and the patient may no longer be deemed a suitable candidate for surgery.
This can effect daily living for the patient and lead to chronic disability.
The medico-legal implications from missing foot fractures are also worth considering [1-2].
With this is mind,
if there is any ambiguity as to whether or not a fracture is present it is the responsibility of the radiologist or reporting radiographer to suggest an appropriate imaging modality to correlate with the initial plain radiograph.
This may include a repeat radiograph after a certain time period,
CT or MRI imaging (Fig.
2,
Fig.3) [3].
Wei et al.
carried out a systematic analysis of missed extremity fractures on initial radiological report over a 6 month period in the Emergency Department.
The overall error/miss rate was 3.7%.
The highest error rate was in diagnosing foot fractures on plain radiography with a miss rate of 7.6% (Table 1) [4].
Table 1.
Site
|
Miss rate
|
Foot
|
7.6%
|
Elbow
|
6%
|
Hand
|
5.4%
|
Wrist
|
4.1%
|
Shoulder
|
1.9%
|