Fractures of the Fingers Missed or Misdiagnosed on Poorly Positioned or Poorly Taken Radiographs: A Retrospective Study
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Background: Missed fractures, the most common diagnostic error in emergency departments, are usually the result of a misread radiograph or the failure to obtain a radiograph. However, a poorly positioned or poorly taken radiograph may also result in diagnostic errors. We sought to analyze the frequency of missed or misdiagnosed finger fractures that could be attributed to inadequate radiographs. Methods: We reviewed the medical records of the hand surgery divisions of Istanbul Bilim University Medical Faculty Hospital and the Orthopedics Department of Private Florence Nightingale Hospital between January 2008 and March 2010 for patients with fractures of the fingers that had been missed or misdiagnosed on the basis of inadequate radiographs. Results: In 182 patients, we identified 7 missed and 7 misdiagnosed fractures of the fingers because of inadequate radiographs. Lack of a true lateral radiographic view of the fingers or a true anteroposterior radiographic view of the thumb was the most frequent reason for diagnostic errors (71%; 10 of 14), leading to missed fractures in six patients and to misdiagnosed fractures in four patients. Superimposition of the fingers on lateral radiographs led to misjudging of displaced proximal phalangeal fractures of the fifth finger in three patients. Conclusion: Diagnostic errors attributed to inadequate radiographs are rare. Proper radiographic evaluation of finger trauma requires at least true anteroposterior and lateral views. An oblique view can complement the lateral view but not replace it. Poor quality radiographs or inadequate views should never be accepted or used as a basis for treatment.