Traumatic fractures in adults: missed diagnosis on plain radiographs in the Emergency Department

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Antonio Pinto
Daniela Berritto
Anna Russo
Federica Riccitiello
Martina Caruso
Maria Paola Belfiore
Vito Roberto Papapietro
Marina Carotti
Fabio Pinto
Andrea Giovagnoni
Luigia Romano
Roberto Grassi


missed diagnosis, diagnostic error, fracture, emergency radiology, conventional radiography


Radiography remains the imaging standard for fracture detection after trauma. The radiographic diagnosis of most fractures and dislocations poses little difficulty to radiologists: however, occasionally these injuries are quite subtle or even impossible to detect on radiographs. Missed diagnoses of fracture potentially have important consequences for patients, clinicians, and radiologists. Radiologists play a pivot role in the diagnostic assessment of the trauma patients: emergency radiologists who are more practiced at seeking out and discerning traumatic fractures can provide an invaluable service to their clinical colleagues by ensuring that patients do not endure delayed diagnoses. This is a narrative review article aims to highlight the spectrum of fractures in adults potentially missed on plain radiographs, the causes of error in diagnosis of fractures in the emergency setting and the key elements to reduce misdiagnosis of fractures. 



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