Freed H A, Shields N N
Ann Emerg Med. 1984 Oct;13(10):900-4. doi: 10.1016/s0196-0644(84)80666-6.
A retrospective review was made of fractures for which radiographic manifestations were missed by various physicians working in the ED. It revealed that fractures of three anatomic sites were being missed disproportionately often--fractures of the navicular, elbow, and calcaneus. Fractures of these sites were the most likely to be missed when present. This effect was so pronounced that elbow fractures were missed as often as phalanx fractures, even though phalanx fractures were seen in the ED more than three times as frequently. The sites with the most missed fractures in gross numbers were ribs, elbow, and the periarticular region of the phalanges, with these three sites accounting for 38% of all missed fractures seen. The elbow was the only site occurring both on the list of fractures missed disproportionately often and on the list of fractures missed most frequently. Some common fractures were not missed at all (Colle's fracture), and others were missed infrequently (hip fracture, midshaft long bone fracture). Knowledge of those fractures that are most likely to be missed makes possible a more directed educational effort.
对急诊科医生漏诊的具有放射学表现的骨折病例进行了回顾性研究。结果显示，三个解剖部位的骨折漏诊比例过高，分别是舟骨、肘部和跟骨骨折。这些部位的骨折在存在时最容易被漏诊。这种影响非常显著，以至于肘部骨折的漏诊率与指骨骨折相同，尽管指骨骨折在急诊科的就诊频率是肘部骨折的三倍多。漏诊骨折总数最多的部位是肋骨、肘部和指骨的关节周围区域，这三个部位占所有漏诊骨折的38%。肘部是唯一既出现在漏诊比例过高的骨折名单上，又出现在漏诊频率最高的骨折名单上的部位。一些常见骨折根本没有被漏诊（科雷氏骨折），而其他一些骨折漏诊较少（髋部骨折、长骨干中段骨折）。了解那些最容易被漏诊的骨折有助于进行更有针对性的教育工作。
