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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Original poster

Missed fracture?

79 replies

maryandhersheep · 14/08/2021 19:01

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?

OP posts:
60sbird · 15/08/2021 08:14

I had an X-ray done on my face many years ago and was told it was all clear (ex chucked a large mug at my face) 3 days later senior radiologist looked at X-ray and called me up, I had an elevated zygoma (broken cheekbone) and it was trapping my jaw from moving, I needed surgery to place a metal plate in my face to repair it

TurquoiseDress · 15/08/2021 08:18

Yes absolutely they do

Our local hospital has a radiologist review & report all the A&E x-rays and sometimes a fracture is discovered then

It happens, but the radiologist review is a safety net to ensure they all get picked up

54321nought · 15/08/2021 08:25

It can be impossible to tell if a bone is broken. It really isn't clear at all in many case. I remember being shown an x ray of my son's joint when he was going through a growth spurt. It looked like a jigsaw puzzle! The doctor explained that all the lines and zig zags I could see were completely natural and expected, but there was no way of knowing if one of them was actually a hairline fracture. Of course it would be damaging to put a join in plaster if it didn't need it, so he was just given a sling, and told to rest it for a few days and see what happened. |It was significantly better within a week. Still don't know if it was broken or not, but clearly only very small break if it was

LongTimeMammaBear · 15/08/2021 08:33

Yes. Fell a d thought I twisted my ankle. A friend looked at it and said let’s go to A&E just to check. X-ray was read and indicated broken ankle. Left with temporary cast and appt for fracture clinic 2 days later at which the orthopaedist on duty x Ray again snd say broken foot as well, requiring surgery for multiple pins in both ankle and foot

Littleone638 · 15/08/2021 08:34

I slipped on a wet floor and fell onto my outstretched hand, went to A&E and had X-rays and they said they thought I’d broken my elbow although they couldn’t see the fracture (there was a lot of swelling), went to the fracture clinic 48 hours later, same story and they said they thought the fracture was on the inside of the joint so couldn’t be seen on X-ray but would treat it as broken, although treatment was to wear a sling and rest it for 10 days. Still have occasional pain in it 6 years later so fairly sure it was broken!

lolifjs · 15/08/2021 08:40

Yes fractures are missed all the time.

X-rays pros: quick, convenient, will show a large obvious fracture clearly

X-ray cons: smaller fractures may not show or may be missed by person reading X-ray

All X-rays done as part of ED attendance will be reviewed within a few days by a specialist to try and pick up missed fractures ASAP.

But sometimes X-ray is at the wrong angle or the fracture is just too small. I always safety net patients that if things are really not improving after 4/5 days they can return for reassessment.

Wakeupin2022 · 15/08/2021 08:44

They spotted the small fracture with DD but missed the totally obvious dislocation that had also happened.

Spotted 4 weeks later when we thought it was time for cast to be removed and operation required .

caringcarer · 15/08/2021 09:01

I had a missed fracture in my foot. Went to A&E. Had x-ray. Nurse reviewed and said no fracture just bad sprain. Next day hospital rang, hairline fractured in 2 places I had to go back, given crutches.

Aprilinspringtimeshower · 15/08/2021 16:17

@Mischance

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.

Yes, agree with this. My eariler post about missed metatarsals break. I have had all sorts of mobility issues as a consequence. Weak muscles, poor balance, and issues on the other foot becuase of all the weight bearing it did for so long (plantar fasciaitis, Achilles tendinitis etc). Seeing a physio again this year for issues- now 4 years since it happened
Arriettyborrower · 15/08/2021 16:36

Have you been seen again OP? Fractures do get missed for all the reasons given by PP above, it can be really tricky to see a bony issue immediately post injury, it isn’t necessarily negligence when missed, this is why all xrays are reviewed by a radiologist.

A Lis franc fracture can be really difficult to diagnose and usually requires further imaging, I would be concerned this may be what you have experienced, what was your mechanism of injury?

Arriettyborrower · 15/08/2021 16:37

As in how did your foot move/flex in the rabbit hole?

WeAllHaveWings · 15/08/2021 16:48

My boss fell off his bike and hurt his arm, xrays were clear, but he still had problems with straightening his arm so they sent him to physio where the physio painfully manipulated his arm for a few weeks and gave him exercises to do.

When it was still very painful they sent him back for another xray and found the fracture. By that point it was too late to do anything, he still cant fully straighten his arm, gets pain some days and had to give up golf and squash.

Original poster
maryandhersheep · 15/08/2021 17:59

Thanks everybody!

@Arriettyborrower - No not yet,
I'll go to GP tomorrow.

It turned outwards. Only one small bruise on side of foot just above the sole. The pain and swelling is on the outside of the foot between the little toes and the ankle. I can weightbare on the big toe side but still can't put the other side of the foot to the floor.

Can weight bare on the

OP posts:
Arriettyborrower · 15/08/2021 18:03

Maryandhersheep go back to wherever you were seen, your GP will have limited resource. Wherever you were seen should have had it reported by now, if you are still not weightbearing they may want to see you in fracture clinic.

MissJeanLouise · 15/08/2021 18:20

My son was x-rayed after a football injury - no fracture reported, given crutches but told to start walking on it. When after a week his leg was locked in the bent position and he was completely unable to put his foot to the floor, we took him back to the MIU; the nurse shouted at him that he wasn’t trying and if he ‘refused to walk’ on it she’d have to send him to A&E and ‘he’d be waiting ages’. At A&E they didn’t do a new x-ray, just reviewed the old one: “No, not broken, maybe a ligament injury.” A week later he had an MRI, followed by an urgent phone call from the radiologist - “Don’t let him walk on it, he’s fractured his distal femur!”. Hairline fractures don’t always show up straight away, I just wish they’d done a second x-ray when we went back; it probably would have shown up, saving him a week of pain.

dopeyduck · 15/08/2021 20:30

Really common to miss them. As a child I was seen in A&E suspected fracture to wrist and was told after an x-Ray there was actually no fracture and it was just a sprain, however due to the level of swelling they booked me a follow up in 48hrs time, when I was taken the dr looked at the original x-ray and said it was in fact fractured. They repeated the x-ray from different angle and actually there was 3 fractures. Apparently extreme swelling (it was extreme!) can impact on the quality of images.

Frazzledbutcalm · 15/08/2021 20:46

We’ve had many missed fractures Angry

3 wrists
1 collar bone
1 toe

4 of these were blatantly obvious and just downright missed. 1 was complex, very rare. However I begged for ct scan or mri as my dd couldn’t even hold/grip a piece of paper - but no, the consultant knew better Hmm … 3 months later they finally, reluctantly agreed to a ct scan, and me then chasing up the results as I’d heard nothing Angry, I was told ‘oh the consultant needs to see you urgently’ Hmm …. It took 18 months for dd to be able to use her hand properly. Raging does not come into it.

So yes, fractures are very often missed in my experience.

MacavityTheDentistsCat · 15/08/2021 21:07

Did you have a thread about your daughter's wrist at the time Frazzled? It vaguely rings a bell ...

Gindrinker43 · 15/08/2021 21:48

There is a number of reasons for missed fractures. It's expected that every Emergency Department will have a percentage of missed fractures and usually have a process for picking up the ones where a clinician hasn't spotted it and it's come up on reporting.
X-ray interpretation takes experience so mistakes do happen.

happyjules · 15/08/2021 22:14

Yes, the years ago I had a slight spinal fracture that was missed following a bad call from my horse. They did stage it would not have affected treatment ( which was none). I received the letter a month after the fall.

Rainbowsew · 15/08/2021 22:39

Op - I'm a Radiographer, there should always be two views of a foot or ankle. One with your foot flat on the x-ray cassette and one with it slightly turned inwards.

For the ankle your leg should be out straight with toes point upwards and one with leg on the side.

Don't go to GP it'll waste your and their time, they will just probably refer for xray again. Go back to A&E and ask for review if it is that bad, but don't forget that even soft tissue injuries can be very painful for a while, the doctor or nurse you saw should "treat the patient not the x-ray" so if in pain but no fracture seen they should have given advice on rest and painkillers etc

Fractures can be missed either by inexperienced eyes, poorer quality screens in A&E or due to patient condition or quality or image. They can also be picked up later when healing begins.ifit was only 3 days ago hopefully your x-ray will be reviewed by radiology tomorrow anyway.

FrangipaniDeLaSqueegeeMop · 15/08/2021 22:41

My son's broken arm got missed as they only x-rayed the lower arm near the wrist not the whole arm for some reason. poor little thing got sent home with a sling and wandered about with a broken arm for 2 days before I went back and demanded they check again as I just KNEW something was wrong with him.

tsmainsqueeze · 15/08/2021 22:48

@CovidCorvid

* My manager on the other hand walked round (with great difficulty it has to be said) with a fractured tibia for eight weeks. Her GP insisted it was tendinitis and she had to keep using the leg. She had to beg and beg again to get the scan that showed the fracture.

I walked around for nine months with a broken fibula….it never healed…probably because I kept running the whole time even though I was in agony. I actually ran 7k the evening before they finally put me in a plaster cast.

My son had a hairline fractured tibia missed on xray ,was quite painful as he carried on working, running etc , until it fractured fully and he heard it crack !
Mischance · 15/08/2021 22:57

It is inevitable that some fractures will be missed. That is a given.

But what bugged me was that no-one would listen when I told them I could not weight-bear - they were so patronising. If they had taken what I was saying seriously there might have been some hope that I would not now be walking with a stick; that my lovely walking holidays are now impossible; that I cannot even think about running.

Staff should know that it is possible for fractures to be missed and alarm bells should start ringing, which should result in them looking a bit closer.

Original poster
maryandhersheep · 15/08/2021 22:59

@Rainbowsew

Op - I'm a Radiographer, there should always be two views of a foot or ankle. One with your foot flat on the x-ray cassette and one with it slightly turned inwards.

For the ankle your leg should be out straight with toes point upwards and one with leg on the side.

Don't go to GP it'll waste your and their time, they will just probably refer for xray again. Go back to A&E and ask for review if it is that bad, but don't forget that even soft tissue injuries can be very painful for a while, the doctor or nurse you saw should "treat the patient not the x-ray" so if in pain but no fracture seen they should have given advice on rest and painkillers etc

Fractures can be missed either by inexperienced eyes, poorer quality screens in A&E or due to patient condition or quality or image. They can also be picked up later when healing begins.ifit was only 3 days ago hopefully your x-ray will be reviewed by radiology tomorrow anyway.

Thank you so much! That's really helpful. I'll go back to a&e tomorrow!

Will report back!

OP posts: