Journal of Musculoskeletal Trauma

Analysis of Missed Fractures in Polytrauma Patients: Ki Chul Park, Hyun Uk Kim; J Korean Fract Soc 2014;27(4):281-286. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.281

Abstract PDF: PURPOSE
The purpose of this study is to determine the frequency of missed fractures in severe multiple trauma patients and to analyze any differences in treatment plan, after whole body bone scan.
MATERIALS AND METHODS
From September 2012 to December 2013, 49 patients were confirmed to have multiple trauma with an injury severity score (ISS) of 16 or higher. Whole body bone scan was performed at an average of 15.7 days (7-25) after injury. Missed fractures were diagnosed according to physical examination and additional radiologic reports. Locations and patterns of missed fractures were analyzed. We evaluated any differences in treatment plan after the diagnosis of missed fractures.
RESULTS
Missed fractures were diagnosed in 14 patients (16 cases) on the whole body bone scan. The most frequent location was the knee (three cases), followed by rib, clavicle, carpal bone, and foot. Seven cases were occult fractures, five cases were undisplaced fractures and four cases were displaced fractures. Conservative treatment was administered in 15 patients and surgery was necessary in one patient.
CONCLUSION
Delayed or missed diagnosis of fractures occurred frequently in patients of multiple trauma with a high ISS. Whole body bone scan appears to be effective in finding missed fractures in the whole body. Definitive assessment should be supplemented after initial trauma care in order to reduce the rate of missed fractures.

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False Negative Bone Scan in 56-year Old Man with L2 Compression Fracture Performed 78 Hours after Trauma: A Case Report: Jeong Gook Seo, Hae Kyun Joo, Sung Tae Kim; J Korean Fract Soc 2010;23(4):386-390. Published online October 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.4.386

Abstract PDF: It is very rare that the bone scan after 72 hours from the trauma doesn't exhibit the increased radio-nuclide uptake in the patient with fracture. The purpose of this study is to report the case that indicate the false negative finding in the bone scan performed after 78 hours from the trauma in the 56-year-old man with L2 compression fracture, including a review of the relevant literatures.

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The Clinical Signifiance of Bone Scan in Fracture Diagnosis: Joon Young Kim, Young An Choi, Byoung Kuk Noh, Bo Seuk Kong; J Korean Soc Fract 1988;1(1):102-108. Published online November 30, 1988; DOI: https://doi.org/10.12671/jksf.1988.1.1.102

Most of fracture is easily diagnosed by simple roentgenological studies. However, certain fracture, especially rib and spine are not well definable in scout film desite the suspicious clinical findings. For these cases, we can confirm the fracture by use of whole body bone scan, CT scan and M.R.I We performed Tc bone scan and found out 27 cases of the definite fracture that were considered contusion at initial roentgenological studies from March 1987 to April 1988. We present the following results: 1. In general, the incidence of positive findings on bone scan is higher by the 7 days after trauma. 2. The bone scan is especially valuable for detection of occult rib and spine fracture. 3. It is necessary to perform the interval bone scan in the case of clinically suspicious fracture even if negative initial bone scan.

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The Comparison of Bone Scan and MRI in Osteoporotic Compression Fractures
Jung-Hoon Kim, Jong-In Kim, Bo-Hoon Jang, Jung-Gook Seo, Jin-Hwan Kim
Asian Spine Journal.2010; 4(2): 89. CrossRef

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