Abstract
Diagnosing musculoskeletal pathology from radiographs is an important skill in orthopaedics and emergency medicine. Knowing which fractures are more likely to be missed allows a high index of suspicion when looking at certain radiographs. Likewise, knowing which fractures will be rigorously followed up if they are missed helps to increase index of suspicion for those fractures. Therefore we used a prospectively gathered database of missed radiographic diagnoses to determine which injuries are missed most commonly and how these injuries are followed up.
Four hundred and thirty two missed radiographic diagnoses were recorded from a total of thirty seven thousand, two hundred and seventy nine radiographs (37,279) in an emergency medicine department over three years. The most common area in which fractures were missed was the foot (22%), followed by hand (19%) and wrist (15%). The most common diagnosis to be missed was fracture of a proximal phalanx, followed by fracture of a distal radius and fracture of a metatarsal. The hip, knee, cervical spine and wrist were the areas most likely to be followed up, each with 32–35% of missed diagnoses being followed up in this way. The areas most likely to be further imaged with CT or MRI were the knee and hip. Two of the missed fractured femurs were managed operatively.
Our results show that missed radiographic diagnosis are most commonly of the foot and hand, and that missed diagnosis of knee and femur fractures are followed up most rigorously. By showing which radiographs are most likely to contain missed fractures, and what these fractures are, we allow orthopaedic trainees to increase their level of diagnostic suspicion when reviewing these radiographs.
