Missed Fracture

[JJTDH]

DD went over on her ankle while ice-skating Friday evening. When she got home and I had a look her ankle was significantly swollen and she couldn't walk on it so I took her off to A&E.

Doctors strikes meant we had to wait a while but eventually the doctor called us back to have a look. He prodded at her ankle and my daughter said the pain was more at the front of her foot where the growth plate was than where the main swelling was.

Anyway we waited a little longer while he had a look at the x-rays then he came and back and told us that both command his colleague had looked at the x-rays but couldn't see any obvious break. He did say they saw a slight abnormalities where my daughter said it hurt but they said it's really hard to fracture that so they weren't concerned.

He then tried to get my daughter to walk on her food but she was sobbing with the pain so he gave us a boot to support her and said her x-rays would be sent off to a radiologist to review. Obviously I know radiology won't be open over the weekend so we need to wait and with Christmas it might be longer.

The walking has come down some but Dd still can't walk on her foot.

So can fractures be missed. If they have will radiology pick them up? I don't know how not work.x

Yes fractures can be missed.

Yes radiology can pick them up.

They can, which is the reason xrays are reviewed by specialists. However sprains can also be very painful.

the treatment Would be the walking boot anyway?

If it's fractured, she probably wouldn't be allowed to weight-bear on it for 4-6 weeks.

Oh, my mistake. I was specifically told to use mine when it was fractured - sorry.

My son has a missed fracture on his ankle. We were sent home with words of advice to weigh bear on it.
We arrived home to find a message on the landline answer machine asking us to come back to the hospital.

Thanks. This was late Friday morning, early Saturday evening. I've no idea if X-rays are reviewed on a weekend. She's in a lot of pain with it and painkillers aren't touching it.

Thanks. Wasn't sure if it was reviewed over weekends or whether it won't be looked at until tomorrow and with Christmas coming I was just a bit worried.

My DS broke his wrist in two places. They didn't think it was broken when looking at the xray but the next day they called us an asked us to come back as they had spotted the breaks when reviewing the slides.

Yep, fractures can be missed. .. subtle ones are hard to see .. specialists radiologists have super-powers
all our fracture XR’s are read by Ai before a proper radiologist … I promise you, a real radiologist is much much better.

This.

I have both sprained and broken an ankle. The sprain was a million times worse.

Far, far more painful than the break, three times as much swelling. And after my sprain was technically healed, I had twinges in that ankle for literally years if I bent it the wrong way. With the broken one it was as good as new after 6 weeks and never bothered me since!

yeah I had a small break missed when I went over on my ankle. Only discovered after GP re-xrayed and it showed up. I'd go back for another X-ray when the swelling has gone down.

Yes - DD had a fracture in a bone in her hand from a smash with a hockey stick ( a foul) when she was 9. It was missed and now causes her a lot of trouble with writing for any length of time. Do make sure that the xray is reviewed (I didn't) and it wasn't until a consultant looked a few years later that the break was spotted.

Are they looked at over weekends? Or just Monday to Friday?

I'm just going by what my partner was told when he fractured his - he wasn't allowed to put any weight on it at all for the first four weeks. I think he was allowed to start weight bearing very carefully and briefly after that, but only after a second x-ray and a different cast. Different types/fracture sites must have different rules though. His was some weird bone that they told him was very unusual to fracture.

@JJTDH your poor daughter. I hope you get some advice tomorrow and better pain relief for her at least.

DD's wrist fracture was missed. She was sent home on a Friday evening after xrays in A&E and was told everything was fine.

She did a dance show on the Saturday. She changed her routine slightly so she didn't have to do anything much with her sore wrist.

Got a phone call on the Monday morning to fetch her from school and take her straight back to A&E. The xray review showed a compound fracture. A small fracture but a clear one that should not really have been missed.

To this day I can't believe she did a dance show with a wrist fracture. She says by then it was a bit sore but not too bad at all.

Yes a few years ago I broke my hand bad enough to need it screwed back together and it was initially missed, they sent me home with a suspected broken finger buddy taped to the one next to t, then I got a call a few days later asking me to go back for more X-rays and ended up in surgery that afternoon. Some fractures aren’t obvious at first look, so as a general rule most X-rays go through a second review within 72 hrs by a different person. At that point patients are called back if there are any concerns.

It is possible there is an avulsion fracture, and they can be missed by x-ray. My dd's one in her foot was only picked up by an MRI scan.

Most hospital units run a virtual fracture clinic. Your dd may have been seen by the ED doctor or maybe an orthopaedic junior doc. The images from the xray will likely be reviewed by the trauma consultant in the morning and they will call her in if they feel she needs additional treatment. If you don't get a call in the next couple of days and she is still struggling even with the boot, go back to A&E. Soft tissue injuries can be very painful with lots of initial swelling and may take several days to settle down. Rest, ice, compression, elevation

Just an update. My daughter has an appointment at the fracture clinic next week. What will happen here as they said it wasn't broken and we headed out in a boot.

Yes fractures can definitely be missed. Treat it as a fracture until you know more.

I would keep using the boot, don't over do it, walk a lot, until she gets to the fracture clinic. Elevate whenever possible to help with swelling/pain. It is pretty usual to have some time between x-ray and going to the fracture clinic.

When my son fractured his elbow they picked it up in the x-rays in A&E. They put it in a huge back slab to keep it stable which helped the pain, but he didn't go the fracture clinic until the following week, they needed to wait until the swelling went down before deciding what to do next.

I fractured my ankle in late October, just a 4-5mm fracture and they picked it up at A&E and again I didn't go to the fracture clinic until the following week. I didn't get a moon boot as the fracture was stable and I could weight bear. 2 months on I still struggle with stairs, walking too far, can't drive, I am very slow and my foot still feels numb across the top. The physio gave exercises and said it could take several months to get full movement back (but I am older, mid 50s, your dd may heal quicker!)

They may re X-ray it and check her weight-bearing and flexibility.

Thanks all for your advice. Had her appointment today and she's got an avulsion fracture. In the boot for another 3 weeks and then we've been referred for physio too x