Distribution of occult fractures detected in emergency orthopedic patient trauma with computerized tomography.

BACKGROUND: Computerized tomography (CT) is a very useful diagnostic method in orthopedic emergency cases where fractures are suspected but cannot be detected through direct radiography, or when the fracture is detected in direct radiography but better evaluation of the anatomical structure is necessary. In this study, we analyzed occurrences of missed fractures in radiographs that were subsequently diagnosed in CT scans.

METHODS: This was a retrospective study. We examined the medical records of all orthopedic trauma patients who visited our hospital's emergency room due to orthopedic trauma between January 2010 and January 2011 and whose spine, pelvis and extremity CTs were taken.

RESULTS: Occult fractures were detected using CT in 12 (6.6%) of the children and 102 (6.8%) of the adults. We detected cervical vertebra fractures in 23 patients, femoral neck fractures in 6 patients, and tibia plato fractures in 5 patients, which can cause complications unless immediately acted upon in the emergency room.

CONCLUSION: CT revealed most missed diagnoses and proved that direct radiography is less capable of detecting fractures of some critical regions. Where there is clinical suspicion, we recommend that before conservative treatment of patients, especially in cases of possible cervical spine and pelvic region fractures, CT should be requested, even if the radiography is normal.