title: Delayed identification of skeletal injury in multisystem trauma: the 'missed' fracture.
abstract: Delay in diagnosis of musculoskeletal injury in multiply injured patients may potentially lead to functional or cosmetic disability in survivors. In an 18-month prospective study to determine the incidence and spectrum of delayed recognition of skeletal injury at our Level I trauma center, delayed diagnosis of 39 fractures was made in 26 of 1,006 consecutive blunt trauma patients. The delay in recognition ranged from 1-91 days. Twenty-one (55%) of the fractures were not X-rayed at the time of admission, but nine (23%) fractures were clearly visible on admission films. Four (10%) fractures were missed because of technically inadequate X-rays, and five (13%) had adequate X-rays but could not be identified on admission films. In only two instances was a second anesthetic exposure required for operative therapy. For the patients in this series, the delay of fracture identification was not felt to contribute to additional long-term cosmetic, functional, or neurologic problems. Continued clinical and radiologic surveillance is required in multiply injured patients to prevent musculoskeletal diagnostic failure.
authors.affiliation: Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, Camden 08103.
authors.forename: C T
authors.initials: CT
authors.lastname: Born
authors.forename: S E
authors.initials: SE
authors.lastname: Ross
authors.forename: W M
authors.initials: WM
authors.lastname: Iannacone
authors.forename: C W
authors.initials: CW
authors.lastname: Schwab
authors.forename: W G
authors.initials: WG
authors.lastname: DeLong
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D004630:Emergencies; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis*; D011446:Prospective Studies