Title : Missed hind foot fractures – Worth a second look?
Abstract:
Injuries of the foot and ankle are common in any ED department, with nearly half a million patients presenting with a first diagnosis of hindfoot or ankle sprain in the UK in 2023/24. Plain radiographs remain the standard initial imaging offered. However, fractures continue to be most common type of missed injuries, owing to various pitfalls and limitations on plain radiographs including overlapping bones despite multiple projections, difficulty in interpretation, presence of normal variants not to mention lack of awareness and experience. Over the years, there has been a steady increase in claims and litigations related to misdiagnosed hindfoot and ankle fractures. Although claims related to missed fractures are relatively low volume and low financial value, missed fractures present a real financial cost to the NHS and can have a serious and prolonged impact on both patients and the staff who treat them.
Materials and Method: This presentation will focus on the most clinically and medicolegally relevant fractures of the hind foot, that are at a higher risk of being overlooked, which would be beneficial to imaging interpreters of any grade cross specialties. The areas covered include various processes of the talus and calcaneum with a short review of avulsion fractures related to the distal tibiofibular joint. The article will discuss the anatomy and mechanism of injury, with illustrations and a short review of the implications of missing such injuries.
Conclusion: With litigations related to missed fractures on the rise, it is critical to understand the role and limitations of plain film, role of early CT/MRI and interpret the plain films with increased awareness of high risk areas with the maximum incidence of missed injuries. This presentation would be beneficial for trainees, inexperienced and experienced clinicians and surgeons of all grades in raising awareness with a view towards mitigating the risk of missed and delayed diagnosis of the more commonly overlooked fractures of the hind foot (talus and calcaneum). The presentation will not review obvious fractures evident on plain radiographs.
