title: Missed clavicle fractures on anterior-posterior views of skull X-rays: a retrospective, observational, and descriptive study.
abstract: OBJECTIVE
  The clavicle is almost always seen in skull X-rays of infants. The objectives of this study were to determine how often the clavicle and clavicle fractures are visible but missed on the skull anterior-posterior view (skull AP) of infants and which factors are associated with missing the diagnosis.
  
  
  METHODS
  We retrospectively studied patients aged 1 year or younger who had a skull AP taken for any injury survey at a single urban, academic hospital between April 1999 and July 2012. Outcomes of interest were the numbers and percentages of visible clavicles; clavicle fractures, including missed ones on skull AP; and the factors associated with missing the diagnosis of a clavicle fracture.
  
  
  RESULTS
  Both clavicles were visible in 734 patients (89.6%). Of these, 10 patients (1.4%) had confirmed clavicle fractures, and 6 patients (0.8%) had fractures that were missed at presentation. Although we tried to determine the factors that might be associated with missed diagnoses, including age <6 months, male sex, blocking by guardian's hands, associated skull fractures, and mechanism of injury, none was significantly associated with missed clavicle fractures.
  
  
  CONCLUSIONS
  The clavicles were recognizable on skull X-rays in most cases. Therefore, one should check the clavicles when reading skull X-rays.
authors.affiliation: Department of Pediatric Emergency Medicine, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jung-Heon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Pediatric Emergency Medicine, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jeong-Yong
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Pediatric Emergency Medicine, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hyung-Rae
authors.initials: HR
authors.lastname: Cho
authors.affiliation: Department of Pediatric Emergency Medicine, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jong-Seung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Pediatric Emergency Medicine, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Ryu
keywords: Clavicle; Infant; Skull; X-rays