Missed musculoskeletal injuries in a University Hospital in Riyadh: types of missed injuries and responsible factors.

Eighty missed musculoskeletal injuries in 51 patients in King Khalid University Hospital are analysed. The diagnostic failure rate was 0.6 per cent of all injured patients seen in the emergency room and 6 per cent of admissions under orthopaedic care. The three commonest sites of missed injury were the knee (16 injuries), the foot and ankle (14 injuries) and the hip and pelvis (13 injuries). Twenty-four (47 per cent) presented initially with multiple injuries. In 48 of these patients (60 per cent) there were one or more complaints related to the missed injury. Factors responsible for inadequate diagnosis included breaking of clinical routine, inadequate clinical examination, ignoring the patient's complaints and positive physical signs, and lack of or misinterpreted and inadequate X-rays.