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ECR 2019 / C-0357
Foot fractures in the Emergency Department
Congress: ECR 2019
Poster No.: C-0357
Type: Educational Exhibit
Keywords: Trauma, Education and training, Medico-legal issues, Education, Audit and standards, Digital radiography, CT, Conventional radiography, Musculoskeletal bone, Emergency, Acute
Authors: C. McLoughlin1, N. Pathirana2; 1Belfast/UK, 2Dundonald/UK
DOI:10.26044/ecr2019/C-0357

Background

The interpretation and reporting of acute foot fractures on plain radiographs is a challenging task. Reporting errors can lead to delayed treatment and poorer patient outcomes.

 

 

Fig. 1: A transverse dorsal navicular body fracture with subsequent open reduction and internal fixation.
References: 2018 Lineage Medical, Inc. Orthobullets.com

 

The patient may be a suitable candidate for an open reduction and internal fixation procedure under the orthopaedic surgical team (Fig.1). However, with a missed fracture the bone healing process may be too far along and the patient may no longer be deemed a suitable candidate for surgery. This can effect daily living for the patient and lead to chronic disability. The medico-legal implications from missing foot fractures are also worth considering [1-2].

 

With this is mind, if there is any ambiguity as to whether or not a fracture is present it is the responsibility of the radiologist or reporting radiographer to suggest an appropriate imaging modality to correlate with the initial plain radiograph. This may include a repeat radiograph after a certain time period, CT or MRI imaging (Fig. 2, Fig.3) [3]. 

 

Wei et al. carried out a systematic analysis of missed extremity fractures on initial radiological report over a 6 month period in the Emergency Department. The overall error/miss rate was 3.7%.  The highest error rate was in diagnosing foot fractures on plain radiography with a miss rate of 7.6% (Table 1) [4].

 

Table 1.

Site

Miss rate 

Foot

7.6%

Elbow

6%

Hand

5.4%

Wrist

4.1%

Shoulder

1.9%

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