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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

Findings and procedure details


A retrospective clinical audit was performed analysing initial foot x-ray reports on patients presenting to the Ulster Hospital, Emergency Department. The reports were created using the RIS SECTRA system by radiologists and reporting radiographers. The reports were analysed from between December 2016 and March 2017.  


When analysing the reports we assessed;

1. If a fracture was present on the initial x-ray?

2. If no fracture identified, where there was strong clinical concern, was appropriate follow up imaging recommended?

3. If no fracture identified, was there any fracture identified on follow up imaging?


There was no trust guidelines to set as a clinical standard, however 100% sensitivity was the expected standard in identifying the acute fracture sites. 




In total, 734 patients’ radiograph reports were analysed. There were 155 diagnosed correctly with a fracture and 573 diagnosed with no fracture, and requiring no follow up imaging.


There were 5 radiographs that were deemed unequivocal, 4 of which were later diagnosed on CT imaging and 1 by a follow up radiograph 3 weeks later.

There was 1 initial radiograph that was deemed as a missed diagnosis and later confirmed on a follow up radiograph.  The fracture locations included the anterior aspect of the calcaneus, medial aspect of the talus, and base of the metatarsals. An error rate of 0.1% was calculated.      


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