Why tibial plateau fractures are overlooked
| Autor: | Kim Lyngby Mikkelsen, Cecilie Mullerup Kiel, Michael Krogsgaard |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Pittsburgh knee rules lcsh:Diseases of the musculoskeletal system Adolescent Sports medicine Denmark Radiography Physical examination Young Adult 03 medical and health sciences 0302 clinical medicine Rheumatology Tibial plateau fracture X-rays medicine Humans Orthopedics and Sports Medicine Prospective Studies Registries Magnetic resonance imaging (MRI) Prospective cohort study Retrospective Studies 030222 orthopedics medicine.diagnostic_test business.industry Medical record General surgery 030208 emergency & critical care medicine Retrospective cohort study Clinical decision rules Middle Aged medicine.disease Magnetic Resonance Imaging Tibial Fractures Knee fracture Orthopedic surgery Female lcsh:RC925-935 business Research Article |
| Zdroj: | Kiel, C M, Mikkelsen, K L & Krogsgaard, M R 2018, ' Why tibial plateau fractures are overlooked ', BMC Musculoskeletal Disorders, vol. 19, 244 . https://doi.org/10.1186/s12891-018-2170-z BMC Musculoskeletal Disorders BMC Musculoskeletal Disorders, Vol 19, Iss 1, Pp 1-6 (2018) |
| Popis: | Background: Tibial plateau fractures (TPFs) are sometimes overlooked in the emergency room (ER). Using a national register covering 18 years we aimed to find out why and to evaluate if use of a specific radiographic decision rule, Pittsburgh Knee Rules (PKRs), could have reduced the number of overlooked TPFs. Methods: Medical records for 137 patients, prospectively registered during 18 years by the Danish Patient Compensation Association (DPCA) (a national register), were studied. The inclusion criterion was a delayed diagnosis of a fracture in the knee following a trauma. Case records, legal assessments, and evaluations by specialist doctors were reviewed, and the consequences of the delayed diagnosis for outcome and treatment were registered. Results: Only 58 patients (42%) had been evaluated according to PKRs. In 53 patient cases, the fracture was not diagnosed on radiographs obtained at the first medical contact. However, in 84% of these cases, the fracture was visible or was suspected by retrospective evaluation. 50 out of 79 patients, for whom X-rays were not obtained, were candidates for radiographs according to PKRs, 17 cases lacked information to evaluate by PKRs and 12 cases were not candidates. In 53% of all cases, it was evaluated that the fracture position had worsened at the time of diagnosis. A significant disability compensation was granted in 36% of cases due to the delayed identification of fractures, totaling 841,000 EUR. Conclusions: The major reasons for overlooking TPFs were 1) difficulty in recognizing the fractures on X-rays and 2) that X-ray decision rules were not employed. Two thirds of the patients, for whom a radiograph had not been prescribed, would have had an X-ray, if the PKRs had been used. Overlooking TPFs significantly increased patient disability in one third of cases. We recommend that healthcare professionals in the ER use X-ray decision rules in addition to clinical examination to avoid overlooking TPFs. When standard radiographs are evaluated as normal in patients that are clinically suspect of a TPF, oblique X-rays, magnetic resonance imaging (MRI) or Computed Tomography (CT)-scan should be considered. |
| Databáze: | OpenAIRE |
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