The aim of this study was first, to determine
whether CT scans undertaken to identify serious injury to the viscera were
of use in detecting clinically unrecognised fractures of the thoracolumbar
vertebrae, and second, to identify patients at risk of ‘missed injury’. We retrospectively analysed CT scans of the chest and abdomen
performed for blunt injury to the torso in 303 patients. These proved
to be positive for thoracic and intra-abdominal injuries in only
2% and 1.3% of cases, respectively. However, 51 (16.8%) showed a
fracture of the thoracolumbar vertebrae and these constituted our subset
for study. There were eight women and 43 men with mean age of 45.2
years (15 to 94). There were 29 (57%) stable and 22 (43%) unstable
fractures. Only 17 fractures (33.3%) had been anticipated after
clinical examination. Of the 22 unstable fractures, 11 (50%) were
anticipated. Thus, within the whole group of 303 patients, an unstable spinal
injury was missed in 11 patients (3.6%); no harm resulted as they
were all protected until the spine had been cleared. A subset analysis
revealed that patients with a high Injury Severity Score, a low
Glasgow Coma Scale and haemodynamic instability were most likely
to have a significant fracture in the absence of positive clinical
findings. This is the group at greatest risk. Clinical examination alone cannot detect significant fractures
of the thoracolumbar spine. It should be combined with CT imaging
to reduce the risk of missed injury.
Sporting injuries around the ankle vary from
simple sprains that will resolve spontaneously within a few days
to severe injuries which may never fully recover and may threaten
the career of a professional athlete. Some of these injuries can
be easily overlooked altogether or misdiagnosed with potentially
devastating effects on future performance. In this review article,
we cover some of the common and important sporting injuries involving
the ankle including updates on their management and outcomes. Cite this article:
