Missed fracture?

[maryandhersheep]

AIBU to wonder if fractures ever get missed on x rays? Fell down a rabbit hole and nurse said no fracture to foot after X-RAY but 3 days later still can't weightbare and the pain is awful? Any experiences?

@maryandhersheep
It was my arm but if I hadn't seen both xrays I wouldn't have believed it.

OP, I've broken my foot. But the break wasn't the worst pain. The worst pain was the tearing of the something inside. It was like hearing denim rip. It was a horrible noise.

I've also sprained my ankle which was way worse than my broken bone and took a long time to weight bare.

I think it wouldn't be all that unusual if you didn't have a break.

Soft tissue damage really can be agonising.

Yes it is not unheard of on rare occasions to have a hairline fracture missed, particularly if around complex joints or for a number of other reasons.

As it's still extremely painful and you cannot weight bear on your foot after 3 days, it wouldn't be unreasonable to contact 111 again. They'll give advice or send you back to urgent care centre for a further check.

A good clinician also looks at patient presentation not just first X-rays which can on occasion give false negatives for a variety of reasons, so if you are still suffering acute symptoms even further down the line from today in addition after following more advice, don't be afraid to contact again as they may ultimately need to review with more investigations if not healing as expected.

Fingers crossed it is a naughty twisted ankle or soft tissue injury that will recover with rest and following advice.

@evilkitten

Yep. Mine fracture was spotted on x-ray, but nobody did anything about it. For two weeks my GP dosed me up to the eyeballs with Tramadol to 'help me sleep', and eventually I went to a physio who looked askance and said it was bound to hurt as it was broken. Went back to GP who refused to refer back to x-ray because that had already been done. Eventually, I asked for a copy of my hospital notes, and discovered that the x-ray - and radiologist - did spot it was broken and reported it. However, A&E chose not to tell me, my GP, or actually do anything about it.

The moral of this story is that only you have your best interests at heart, and to believe nobody.

Did you make a complaint about what happened?

Yup, totally possible.

Fractured tibial plateau, took 3 weeks and multiple drs visitors and eventually sitting in a&e refusing to move until they looked at the original X-ray (from 3 weeks earlier) and conceded that yes, it probably was broken.

I had three operations, stabilising screws and plates, 6 months in a cast, 3 months in a wheelchair, months of hydrotherapy, years of physio…this wasn’t a small break…

The moral of the story is, if you think there’s an issue, keep pushing.

I don’t take the first answer from any medical professional any more if it goes against my guy instinct.

@DrWhoNowww

Yup, totally possible.

Fractured tibial plateau, took 3 weeks and multiple drs visitors and eventually sitting in a&e refusing to move until they looked at the original X-ray (from 3 weeks earlier) and conceded that yes, it probably was broken.

I had three operations, stabilising screws and plates, 6 months in a cast, 3 months in a wheelchair, months of hydrotherapy, years of physio…this wasn’t a small break…

The moral of the story is, if you think there’s an issue, keep pushing.

I don’t take the first answer from any medical professional any more if it goes against my guy instinct.

This is true. I've had various sprains and know how painful they can be but this is a different sort of pain and feeling.

Sorry to hear about what you had to endure!

Yup - my broken shoulder (rotator cuff) was missed after X-Rays
Was told it was only muscle damage so to keep moving it
6 weeks later I went to the GP as the pain was getting worse and I couldn't move it.
He chased to see the X-Ray and then all hell broke loose!
I joked that it was like the doctor in The Simpson's with his thumb over the break in the X-Ray

Hi, I fell while at work in france, and within 1 hour foot swelled badly and extremely painful to walk on. Clinic there did an X-ray and told me it was not broken. Over next 12 weeks I went to GP numerous times saying I needed physio as so painful. Was refused and told just a sprain
After 12 weeks I went to a physio privately. They spent less than 15 minutes with me before telling me to go to A and e and get a weight bearing X-ray. Turns out I had broken 2 metatarsals. It took me a year to recover because of the damage I did walking on it for so long, and still get aches if walk a long way.
Moral is, yes it can be missed.

Sometimes they do especially of lots of swelling

Not me, but a relative.
Fell from a ladder. Second rung, so less than a meter off the ground. A friday night. So he took a couple of paracetamol and went to bed. He had landed on his shoulder /arm. Said "that's jolly sore" and carried on.
Saturday. Arm/shoulder black with bruising.
Sunday even worse. Can hardly move it.
Monday, he goes to gp. Gp states "as you walked in, and are not curled up in a ball on the floor, screaming. Nothing can be broken. Have these extra strong pain killers and come back in a week if it's not getting better.
It keeps getting worse, so he takes himself to the hospital a and e.
Xray showed ball at the top of arm bone is broken off and has moved half way down his arm.
Breaking a chunk out of the shoulder bone as went past. That bit was moving down his back...
Several screws, plates and wires later...
It started to improve.

I fractured my foot last year, went to walk in clinic and had it x-rayed who said they couldn't see a fracture but to treat it as one which was conservative management and RICE. Still couldn't weightbare 3 Weeks later so went back to walk in and saw the same practitioner as first time. She re x-rayed it and then showed me both of them and the fracture was so much clearer on the second x-ray and couldn't see anything on the first. I guess her point in showing me was that she didn't get it wrong as such, just small fractures aren't always noticeable at first, especially if swelling etc present! It didn't change the treatment however and it took months to get over - even now it still bothers me at times!

Mine was the other way round, the ooo doctor felt my foot and declared it to be a sprain, after a week it did improve then a further week on it suddenly went to ultra painful and an x-ray showed a broken metatarsal, I had to stop driving for weeks and got a funny boot.

My daughters clavicle fracture was missed, picked up on review 3 days later.

Indeed they do miss fractures! I have walked with a stick for years because of this!

I fractured my foot and it was plastered for 8 weeks. Then they took the plaster off and said it was fine - I kept saying it was not as I could not weight-bear at all. Weeks went by with me still on crutches and still they insisted it was fine and I was talking rubbish. I took myself to a specialist orthopaedic hospital who identified the second fracture which should have had surgery right at the beginning, but by then it was too late.

Having a broken foot that does not heal can be life-changing because of permanent impaired mobility. It makes me very angry.

Feet are very complicated structures and need specialist attention.

I’ve broken bones in my feet quite a few times (clumsy don’t ask) one break was in an odd place and they took loads of pictures during the x-ray because it was in such a complicated place and they were adamant it wasn’t broken but when the x-ray was reviewed by the consultant he found it.

maryandhersheep - honestly you need to go back.

It is sometimes hard to identify foot fractures because there are so many bones. The critical factor in my lack of care was that no-one would listen. I kept telling them something was wrong and, instead of going back to the x-rays and thinking again, they just patted me on the head and sent me on my way.

I have a piece of my heel bone still floating around in my foot.

The really important thing here is that a foot fracture is so life-changing if it does not get the proper treatment. I would hate you to finish up like I am.

People will give you anecdotal evidence . Most fractures aren't missed.

But research will tell you that medical staff know occasionally they are. Please see my earlier comment.

If you are experiencing acute pain and difficulty in weight bearing keep talking to your health care practitioners. It may be soft tissue damage that takes a while to heal or it may be something that a clinician will assess and insist in new (different angle or wider placement) X-rays on if not resolving in expected time for what they reasonably assess it as being given what they can see. No test is 100% diagnostic.

I’ve sprained and broken a lot of bones in my body. I can tell you categorically that soft tissue damage can be much, much more painful than a straightforward fracture.

However, breaks and fractures can be misdiagnosed or missed completely.

I would strongly urge anyone and everyone to continue to push for diagnosis and treatment until they are satisfied with the outcome. Make sure everything is explained to your satisfaction. As the patient, you are more invested in your health than the experts. You are the only one that ensure you get the best or most appropriate treatment.

Yes happened to my DM

even the keenest eyes often miss scaphoid fractures (a hand/wrist bone) often these need to be picked up on an MRI.

@fallfallfall

even the keenest eyes often miss scaphoid fractures (a hand/wrist bone) often these need to be picked up on an MRI.

This ^^

But not often

Just on occasion

@maryandhersheep

Oh lawd these aren't promising stories! It's more the foot than ankle. Have had ankle sprains before but this is foot focused and pain is another level. Doctor that first examined it was sure it was broken but was reviewed by somebody else who said he couldn't see anything?! It's impossible to walk on and keeping me up at night. There's one tiny 1p sized patch of a bruise and that is it?!

I would ask for another X-ray but if they still tell you there’s no fracture, then it’s time for an MRI, because it might be a torn ligament. I did torn and partially torn ligaments in both the ankle and the foot at the same time in February (weird story) and the rehab doctor said the foot is actually the most difficult to heal and hurts the longest, even though my ankle was the worst to look at. If you have a bad enough sprain + torn ligament, as long as it doesn’t require surgery, it will be no different than a fracture really as they’ll put you in a fiberglass cast for several weeks and then start physio.

Yep, I broke 4 metatarsals and one of the other bones in my foot and it was missed by X-ray. In fact, the A&E nurse was so sure it was "just a sprain" that she said if it hadn't had been a quiet day, they wouldn't have x-rayed it at all! Sent on my merry way and told to walk on it as normal.
Three weeks after initial X-ray I went to my GP as I still couldn't walk without crutches, had foot drop and it felt like everything was moving around in my foot. Urgent referral to orthopaedics and a CT scan and they discovered the 5 fractures. I had basically broken my foot in half and had something called a Lisfranc injury. It was just sheer luck that the bones hadn't displaced with me trying to weight bear for 3wks or I would have needed surgery. Long recovery and still often have pain in it 4yrs later.

OP, you mention a small bruise. Is it on the top of your foot or on the sole of your foot? If underneath on the sole please go back and get it seen again, bruising underneath the foot is a telltale sign of a Lisfranc injury like I had.

It took four months of me going to my Gp, to two different hospitals for them to realise I had 5 broken bones in my back.