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Missed Fractures in Children

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Errors in Radiology

Abstract

Fractures in children are a common occurrence. Most are overt and easily detected, others are subtle and often overlooked. Missed orthopedic injuries, such as fractures and dislocations, are a common event in accident and emergency practice, particularly in children and young adults. Such injuries can have serious consequences since delays in treatment can result in long-term disability. They are also one of the most common causes of medical-legal issues and comprise the largest source of malpractice claims in the emergency department (ED) [1]. Missed fractures occur for various reasons, among the most important of which in EDs is a junior radiologist’s (or junior physician’s) lack of expertise in child skeletal injuries.

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References

  1. Berlin L (2001) Defending the “missed” radiographic diagnosis. AJR 176:317–322

    PubMed  CAS  Google Scholar 

  2. Swischuk LE, Hernandez JA (2004) Frequently missed fractures in children (value of comparative views). Emerg Radiol 11:22–28

    Article  PubMed  Google Scholar 

  3. Perron AD, Miller MD, Brady WJ (2002) Orthopedic pitfalls in the ED: pediatric growth plate injuries. Am J Emerg Med 20:50–54

    Article  PubMed  Google Scholar 

  4. Della-Giustina K, Della-Giustina DA (1999) Emergency department evaluation and treatment of pediatric orthopedic injuries. Emerg Med Clin NA 17:895–922

    Article  CAS  Google Scholar 

  5. Worlock P, Stower M, Barbor P (1986) Patterns of fractures in accidental and non-accidental injury in children: a comparative study. Br Med J (Clin Res Ed) 293:100–102

    Article  CAS  Google Scholar 

  6. Hernandez JA, Swischuk LE, Yngve DA, Carmichael KD (2003) The angled buckle fracture in pediatrics: a frequently missed fracture. Emerg Radiol 10:71–75

    Article  PubMed  Google Scholar 

  7. Wardrope J, Chennells PM (1985) Should all casualty radiographs be reviewed? Br Med J (Clin Res Ed) 290:1638–1640

    Article  CAS  Google Scholar 

  8. Furnival RA, Woodward GA, Schunk JE (1996) Delayed diagnosis of injury in pediatric trauma. Pediatrics 98:56–62

    PubMed  CAS  Google Scholar 

  9. Petinaux B, Bhat R, Boniface K, Aristizabal J (2011) Accuracy of radiographic readings in the emergency department. Am J Emerg Med 29:18–25

    Article  PubMed  Google Scholar 

  10. Berlin L, Hendrix RW (1998) Perceptual errors and negligence. AJR 170:863–867

    PubMed  CAS  Google Scholar 

  11. Berbaum KS, El-Khoury GY, Ohashi K et al (2007) Satisfaction of search in multitrauma patients: severity of detected fractures. Acad Radiol 14:711–722

    Article  PubMed  Google Scholar 

  12. Guly HR (2001) Diagnostic errors in an accident and emergency department. Emerg Med J 18:263–269

    Article  PubMed  CAS  Google Scholar 

  13. Pinto A, Brunese L (2010) Spectrum of diagnostic errors in radiology. World J Radiol 2:377–383

    Article  PubMed  Google Scholar 

  14. Brook OR, O’Connell AM, Thornton E et al (2010) Quality initiatives: anatomy and pathophysiology of errors occurring in clinical radiology practice. Radiographics 30:1401–1410

    Article  PubMed  Google Scholar 

  15. Crowe J, Swischuk LE (1977) Acute bowing fractures of the forearm in children: a frequently missed injury. AJR 128:981–984

    PubMed  CAS  Google Scholar 

  16. Close BJ, Strouse PJ (2000) MR of physeal fractures of the adolescent knee. Pediatr Radiol 30:756–762

    Article  PubMed  CAS  Google Scholar 

  17. Carey J, Spence L, Blickman H, Eustace S (1998) MRI of pediatric growth plate injury: correlation with plain film radiographs and clinical outcome. Skeletal Radiol 27:250–255

    Article  PubMed  CAS  Google Scholar 

  18. Wei CJ, Tsai WC, Tiu CM et al (2006) Systematic analysis of missed extremity fractures in emergency radiology. Acta Radiol 47:710–717

    Article  PubMed  Google Scholar 

  19. Jadhav SP, Swischuk LE (2008) Commonly missed subtle skeletal injuries in children: a pictorial review. Emerg Radiol 15:391–398

    Article  PubMed  Google Scholar 

  20. Smith BG, Rand F, Jaramillo D, Shapiro F (1994) Early MR imaging of lower-extremity physeal fracture-separations: a preliminary report. J Pediatr Orthop 14:526–533

    Article  PubMed  CAS  Google Scholar 

  21. May DA, Disler DG, Jones EA, Pearce DA (2000) Using sonography to diagnose an unossified medial epicondyle avulsion in a child. AJR 174:1115–1117

    PubMed  CAS  Google Scholar 

  22. Hubner U, Schlicht W, Outzen S et al (2000) Ultrasound in the diagnosis of fractures in children. J Bone Joint Surg Br 82:1170–1173

    Article  PubMed  CAS  Google Scholar 

  23. Williamson D, Watura R, Cobby M (2000) Ultrasound imaging of forearm fractures in children: a viable alternative? J Accid Emerg Med 17:22–24

    Article  PubMed  CAS  Google Scholar 

  24. Cho KH, Lee SM, Lee YH, Suh KJ (2010) Ultrasound diagnosis of either an occult or missed fracture of an extremity in pediatric-aged children. Korean J Radiol 11:84–94

    Article  PubMed  Google Scholar 

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© 2012 Springer-Verlag Italia

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Martino, F., Barbuti, D., Martino, G., Cirillo, M. (2012). Missed Fractures in Children. In: Romano, L., Pinto, A. (eds) Errors in Radiology. Springer, Milano. https://doi.org/10.1007/978-88-470-2339-0_6

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  • DOI: https://doi.org/10.1007/978-88-470-2339-0_6

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2338-3

  • Online ISBN: 978-88-470-2339-0

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