Diagnostic errors and management of foot fractures in patients with multiple or concomitant injuries

About authors

Department of Traumatology, Orthopedics and Field Surgery, Faculty of Pediatrics,
Pirogov Russian National Research Medical University, Moscow

Correspondence should be addressed: Maksim Korolev
Leninskiy prospect, d. 10, korp. 7, Moscow, Russia, 117049; ur.liam@ffelorokrotcod

Received: 2016-03-30 Accepted: 2016-04-22 Published online: 2017-01-05

Delayed or missed diagnosis of foot fractures in patients with multiple or concomitant injuries often leads to the inadequate choice of treatment and causes serious long-term effects. This article reports the most common mistakes accompanying diagnostic procedures and therapy of this injury type. The study conducted in 2007–2015 enrolled 67 patients. Patients were divided into two groups: a prospective experimental group (n = 31) and a retrospective control group (n = 36). For both groups, diagnostic procedures and the range of therapeutic interventions applied were the same, but with the experimental group we used a stepped care approach, followed a specific sequence of activities and adjusted therapy considering the limb condition and the patient’s overall state. In total, we identified 40 and 69 foot fractures in the prospective and retrospective groups, respectively. In the prospective group there were 5 delayed and 3 missed fracture diagnoses; in the second group those numbers were 7 and 9, respectively. The most common factors contributing to diagnostic errors were: excluding radiographic evaluation, severity of patient’s overall condition, poor medical history. Missed fractures were often due to a combination of various factors. A one-step approach was prevalent in the controls (41 fractures); the experimental group underwent a multistep treatment (30 fractures). Therapy outcomes were assessed by Visual Analogue Scale. The results were statistically higher in the prospective group (Mann–Whitney U was 347), which indicates a better treatment applied in this group. The study also showed that using minimally invasive fixation for foot fractures improves treatment outcome.

Keywords: foot fractures, diagnostic error, concomitant injury, multiple injury