Ivan Christopher Davis MD, Presenter: Nothing to Disclose

Brad Van Dyke MD, Abstract Co-Author: Nothing to Disclose

Jeremy F Cuda MD, Abstract Co-Author: Nothing to Disclose

Scott David Wuertzer MD, MS, Abstract Co-Author: Nothing to Disclose

Identify sites of commonly missed fractures in pediatric and adult patients by on-call radiology residents at a level 1 trauma center.

All major discrepancies between initial resident and final attending interpretations on bone radiographs from a Level I Trauma Center over a 5 year period were reviewed. Missed fractures were stratified based on the age of the patient (pediatric < 17 years, adult > 17 years) and the bone fractured. The most commonly fractured bones were then stratified based on location of fracture within the bone.

There was a major discrepancy in 704 reports. Of the discrepant reports, 490 (70%) involved missed fractures. Of the 490 missed fractures, 180 (37%) were in pediatric and 310 (63%) in adult patients. Fractures of the fingers were the most commonly missed, accounting for 16% (n = 29) of missed fractures in children, 10% (n = 31) in adults, and 13% (n =60) overall. In pediatric patients, other commonly missed fractures were: radius (11%), humerus (9%), fibula (9%), tibia (7%), ulna (7%), and metacarpal (5%). In adult patients, other commonly missed fractures were: fibula (7%), vertebra (7%), humerus (6%), radius (6%), tibia (6%), metacarpal (5%), metatarsal (5%), femur (5%), navicular (3%), patella (3%), toe (3%), scapula (3%), and scaphoid (3%). In pediatric patients, the distal humerus, distal radius, and proximal fibula contained the most missed fractures. Missed fractures of the pediatric tibia were evenly distributed proximally and distally. In adults, the proximal humerus, proximal tibia, and distal fibula contained the most missed fractures. Missed fractures of the adult radius were evenly distributed proximally and distally.

Finger, humerus, radius, tibia, and fibula were among the top five missed fractures in pediatric and adult patients. The location of missed fracture within the bone may vary with patients’ age.

Radiology residents commonly miss fractures of the same bones in children and adults. These common fracture sites should be considered during resident education.

Davis, I, Van Dyke, B, Cuda, J, Wuertzer, S, Location of Commonly Missed Fractures in Pediatric and Adult Patients at a Level 1 Trauma Center.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043580.html