Thammaroj Tala, Jianmongkol Surut, Tewattanarat Nipaporn, Panitchote Anupol, Thammaroj Punthip
Department of Orthopedic Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, THA.
Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, THA.
Cureus. 2025 Aug 20;17(8):e90628. doi: 10.7759/cureus.90628. eCollection 2025 Aug.
To investigate the accuracy of radiographic diagnosis of pediatric hand fractures and factors that contribute to diagnostic errors.
We retrospectively reviewed cases of pediatric hand injuries in Srinagarind Hospital, Thailand, from January 2019 to December 2021. A total of 350 patients with accessible radiographs were interpreted by junior/senior radiology trainees, a pediatric/a senior radiologist, and two senior orthopedists. Age, sex, hand side, fracture type, and injury mechanism were collected. Results Among 167 patients with fractures, 55 (32.9%) had multiple fractures. For missed fractures (103 instances), junior radiology trainees missed more frequently than pediatric radiologists, with 35 (34%) vs. 8 (7.8%) instances ( = 0.004). Overall accuracy in the interpretation of different fracture types was 100% for greenstick, 77.4% for torus buckle, 76% for simple fractures. The pediatric radiologist showed the highest accuracy in the diagnosis of Salter-Harris type compared to others, 49 (28.7%) vs. 25-33 (14.6%-19.3%) ( = 0.001). On univariable analysis, vehicle injury mechanism was a borderline negative factor associated with missed fractures (odds ratio (OR), 0.38; 95% confidence interval (CI), 0.14-1.01; = 0.05).
Our findings suggest that review by experienced pediatric radiologists is associated with higher diagnostic accuracy for pediatric hand fractures, particularly Salter-Harris injuries. Prospective studies are needed to determine whether incorporating senior review into routine workflows reduces missed diagnoses.
探讨小儿手部骨折的影像学诊断准确性及导致诊断错误的因素。
我们回顾性分析了泰国诗里拉吉医院2019年1月至2021年12月期间小儿手部损伤的病例。共有350例有可用X光片的患者，由初级/高级放射科住院医师、儿科/资深放射科医生以及两名资深骨科医生进行解读。收集了年龄、性别、患手侧、骨折类型和损伤机制等信息。结果在167例骨折患者中，55例（32.9%）有多发性骨折。对于漏诊骨折（共103例），初级放射科住院医师的漏诊频率高于儿科放射科医生，分别为35例（34%）和8例（7.8%）（P = 0.004）。不同骨折类型解读的总体准确率为：青枝骨折100%，骨皮质压陷骨折77.4%，单纯骨折76%。与其他医生相比，儿科放射科医生在诊断Salter-Harris型骨折方面准确率最高，为49例（28.7%），而其他医生为25 - 33例（14.6% - 19.3%）（P = 0.001）。单因素分析显示，车祸损伤机制是与漏诊骨折相关的临界阴性因素（比值比（OR）为0.38；95%置信区间（CI）为0.14 - 1.01；P = 0.05）。
我们的研究结果表明，由经验丰富的儿科放射科医生进行复查，对于小儿手部骨折尤其是Salter-Harris损伤具有更高的诊断准确性。需要进行前瞻性研究以确定将资深医生复查纳入常规工作流程是否能减少漏诊。
