Clinical Features and Causes of Misdiagnosis and Missed Diagnosis of Occult Fractures

WANG Dong-liang; LEI Zhe-qian; ZHAO Yao-jie

doi:10.3969/j.issn.1002-3429.2016.11.010

Abstract：Objective To analyze clinical characteristics, causes of misdiagnosis and missed diagnosis and prevention measures in order to improve detection rates of occult fractures. Methods Clinical data of 18 misdiagnosed or missed diagnosed patients with occult fractures admitted between January 2008 and January 2013 was retrospectively analyzed. Results Among the 18 patients, 2 patients with femoral neck fractures were misdiagnosed as having hip joint sprain;2 patients with ankle joint epiphyseal injury were misdiagnosed as having sprained ankle;1 patient with femoral neck fracture was misdiagnosed as having early femoral aseptic necrosis;2 patients with sacrococcyx fractures were misdiagnosed as having anal diseases;2 patients with patella longitudinal fractures were misdiagnosed as having knee joint soft tissue injury;1 patient with femoral shaft fractures com-plicated with ipsilateral femoral neck fracture was missed diagnosis of femoral neck fracture;1 patient with cerebral contusion and laceration complicated with cervical spine injury was missed diagnosis of cervical spine injury;2 patients with femoral shaft complicated with ipsilateral acetabular fractures were missed diagnosis of acetabular fractures;1 patient with right femoral neck fractures complicated with posterior acetabular fractures was missed diagnosis of acetabular posterior column occult fractures;1 patient with pleural effusion complicated with rib fracture was missed diagnosis of rib fracture;1 patient with spinal injury, spi-nal cord injury complicated with incomplete paraplegia with ankle joint fracture and femoral neck fractures was missed diagnosis of ankle joint and femoral neck fractures;2 patients with femoral intertrochanteric fracture complicated with femoral shaft and femoral condyle fractures were missed diagnosis of femoral shaft and femoral condyle fractures. Time of misdiagnosis and missed diagnosis was 7-28 d. Among the 18 patients, 17 patients were confirmed by X-ray, CT or magnetic resonance imaging ( MRI) review, and 1 patients was confirmed by intraoperative probing. All patients were immediately treated in accordance with the principles of fracture treatment after confirmed diagnosis. During 6-36 ( 12. 6 ± 2. 4 ) months of follow-up, 15 patients (83. 33%) had primary healing, and 3 patients had complications after treatment. Conclusion Causes of misdiagnosis or missed diagnosis of occult fractures are doctor factor, individual factor, causes of trauma, projection and anatomic factors, and misdiagnosis and missed diagnosis can be decreased by strengthening communication between doctors and patients, enhancing professional training, strictly performing routine physical examination and imaging analysis.