Çolak Ilker, Bekler Halil I, Bulut Güven, Eceviz Engin, Gülabi Deniz, Çeçen Gültekin S
Dr. Lütfi Kırdar Kartal Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
VM Medical Park Kocaeli Hospital, Department of Orthopaedics and Traumatology, Kocaeli, Turkey.
Acta Orthop Traumatol Turc. 2018 Jan;52(1):32-36. doi: 10.1016/j.aott.2017.04.002. Epub 2017 Nov 29.
The aim of this study was to analyze the risk factors contributing to the misdiagnosis of perilunate injuries.
The study included patients who had perilunate dislocation or fracture dislocation correctly or incorrectly diagnosed on initial examination between 2008 and 2014. Data related to the length of time until correct diagnosis of the perilunate injury; cause of injury; presence of associated fractures, polytrauma or concomitant trauma in the ipsilateral upper extremity; time between injury and first presentation; first treatment applied; presence of ligamentous perilunar injuries only or fracture and dislocation; inadequate radiographic assessment; and experience of the physicians were recorded and analyzed.
A total of 44 wrists were included in the study. Of those, 10 (22.7%) wrists (mean patient age: 44.4 years [28 ± 58 years]) with perilunate injuries were misdiagnosed in the initial evaluation. All of the risk factors were found to be similar between the group of patients with correct initial diagnosis and missed diagnosis group, except for the experience of the orthopedic surgeon assessing the injury (p = 0.0001). Of the surgeons who missed the diagnosis, 70% reported that it was their first encounter with a perilunate injury.
The results of this study indicated that lack of experience was the most important factor in the misdiagnosis of perilunate fracture dislocation or isolated dislocation.
Level IV, diagnostic study.
本研究旨在分析导致月骨周围损伤误诊的危险因素。
该研究纳入了在2008年至2014年期间初次检查时月骨周围脱位或骨折脱位被正确或错误诊断的患者。记录并分析了与月骨周围损伤正确诊断前的时间长度、损伤原因、同侧上肢是否存在相关骨折、多发伤或并发伤、受伤与首次就诊之间的时间、首次应用的治疗、仅存在月骨周围韧带损伤还是骨折及脱位、影像学评估不足以及医生的经验等相关数据。
本研究共纳入44例腕关节。其中，10例（22.7%）月骨周围损伤的腕关节（患者平均年龄：44.4岁[28±58岁]）在初次评估时被误诊。除了评估损伤的骨科医生的经验外（p = 0.0001），发现初次诊断正确的患者组和漏诊组之间所有危险因素均相似。在漏诊的外科医生中，70%报告这是他们首次遇到月骨周围损伤。
本研究结果表明，经验不足是月骨周围骨折脱位或单纯脱位误诊的最重要因素。
四级，诊断性研究。
