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Missed pelvic fracture on X-ray (03HDC14447)
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(03HDC14447, 3 November 2004)
Radiologist ~ Reading and reporting of X-ray ~ Pelvic
fracture ~ Standard of care ~ Right 4(1)
A 54-year-old woman presented to the
Emergency Department of a public hospital after falling down some
stairs. She had right-sided buttock pain and, although triage
reported "walking on scene", later examination ascertained that she
could not weight-bear.
A pelvic X-ray was ordered, and an anterior-posterior X-ray taken.
The doctor thought the X-ray did not show any abnormality, and so
she sent the woman home with pain relief medication.
Two days later a senior radiologist read the X-ray, and six days
after that finalised a report in which no fracture was identified.
He did, however, comment that a lateral view of the woman's hip
would be beneficial, in the event of further concern.
Three weeks after the fall, and with pain still persisting, the
woman consulted a chiropractor. She complained of pain in her left
groin. Examination raised enough concern to suggest a pelvic
fracture. The chiropractor requested the hospital X-rays, but was
sent the report only. Consequently, she took her own X-rays. These
suggested a pelvic fracture, and she referred the woman to a
medical centre. Two further X-rays confirmed fractures in the left
superior and inferior pubic rami.
The woman complained that the hospital had failed to diagnose the
fracture, and questioned the adequacy and appropriateness of the
senior radiologist's report.
Expert advice was that the occult fracture was particularly
difficult to identify. Of a pool of radiologists given the prior
history (ie, a fall with right-sided buttock pain) and asked to
examine the X-rays, only one identified the fracture. Although the
report failed to identify the fracture, the radiologist's actions
met the standards of his peers, and neither the radiologist nor the
hospital was found in breach of the Code.
The preference for taking two views of suspected fractures was
confirmed as wise practice, as was the use of magnetic resonance
imaging for problematic hip or pelvic trauma.
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