Mathur Namit, Lau Kenneth K
Emergency Department, Monash Health, 246 Clayton Rd, Clayton, 3168, VIC, Australia.
Monash Imaging, Monash Health, 246 Clayton Rd, Clayton, 3168, VIC, Australia.
Emerg Radiol. 2020 Aug;27(4):377-381. doi: 10.1007/s10140-020-01763-8. Epub 2020 Feb 21.
To assess the incidence of missed Monteggia fracture by radiologists and bedside clinicians (emergency and orthopaedic doctors) at a tertiary hospital.
A comprehensive search was conducted on Picture Archiving and Communication System (PACS) and electronic medical records (EMR) between Jan 2010 and April 2019. All consecutive paediatric and adult patients who presented to the emergency department with the diagnosis of Monteggia fracture were included. The patient's emergency presentation medical notes and trauma film reports were compared. Most emergency presentations were discussed with orthopaedics; hence, this was combined as a single group (bedside clinician group). All images were blindly reviewed by a senior consultant radiologist. Results from the radiologist and bedside clinician groups were compared.
Fifty-one patients were identified; 4 were excluded as they were not true Monteggia fracture on review. Forty-seven patients were included in the study (age range 3-70 years, mean age 15 years). Thirty-three patients (70%) were correctly diagnosed by both groups. Twelve patients (25.5%) had a missed diagnosis by the radiologist's group. Seven patients (14.9%) were missed by the bedside clinicians. Five patients (10.6%) were missed by both groups with fractures detected on re-presentations. The most commonly missed finding was a radial head dislocation/subluxation, followed by a subtle ulnar fracture (confirmed by periosteal reaction development on subsequent radiographs) and an ulnar plastic deformity.
The Monteggia fracture is an important diagnosis, but it is not infrequently missed by radiologists and clinicians. Special attention to the radiocapitellar joint alignment and ulnar periosteum, and looking for a subtle ulnar fracture or plastic deformity would ensure correct diagnosis.
评估在一家三级医院中，放射科医生以及床边临床医生（急诊科和骨科医生）漏诊孟氏骨折的发生率。
对2010年1月至2019年4月期间的图像存档与通信系统（PACS）和电子病历（EMR）进行全面检索。纳入所有连续就诊于急诊科且诊断为孟氏骨折的儿科和成年患者。比较患者的急诊病历和创伤影像报告。大多数急诊病例会与骨科医生讨论；因此，将其合并为一个组（床边临床医生组）。所有图像均由一位资深放射科顾问医生进行盲法评估。比较放射科医生组和床边临床医生组的结果。
共识别出51例患者；经复查，4例因并非真正的孟氏骨折而被排除。47例患者纳入研究（年龄范围3 - 70岁，平均年龄15岁）。两组均正确诊断出33例患者（70%）。放射科医生组漏诊12例患者（25.5%）。床边临床医生漏诊7例患者（14.9%）。两组均漏诊5例患者，这些患者再次就诊时发现有骨折。最常漏诊的表现是桡骨头脱位/半脱位，其次是细微的尺骨骨折（后续X线片上骨膜反应的出现证实）和尺骨塑性变形。
孟氏骨折是一项重要诊断，但放射科医生和临床医生并非不常漏诊。特别关注桡肱关节对线和尺骨骨膜，并寻找细微的尺骨骨折或塑性变形可确保正确诊断。
