Hidden fractures; early diagnosis

Abstract

Background: A hidden fracture is defined as that which is not evident radiographically or that in which the initial interpretation fails or the diagnosis is delayed. This diagnosis is always confirmed retrospectively by the use of different imaging tests. The objective of this study is to review the most common sites of these injuries, as well as the age of the patient, concomitant pathologies, type of trauma, and time interval from initial assessment to definitive diagnosis.
Materials and methods: Retrospective, descriptive, series of cases, evidence level IV, with a total of 13 patients, in the period from April 2013 to March 2014, on whom clinical and radiological assessments were initially performed that showed no fractures. An assessment was made using the Mink and Deutsch classification. The definitive diagnosis was made from CT and/or MRI scans.
Results: The study included 5 males and 8 females, with a mean age of 48.3 years., the type of trauma was direct in 11 patients and indirect in 2 patients, the intensity of the trauma was low energy in 5 patients and high energy in 8 patients. The most common sites of fractures were the distal femur and proximal tibia, followed by proximal humerus and proximal femur. The time interval between the initial injury and the final diagnosis was a mean of 7.4 days. According to the classification of Mink and Deutsch classification, 11 patients were type III, and 2 were type II. An MRI scan was the definitive diagnostic method in 92.3% of the cases.
Discussion: The possibility of hidden fractures should always be taken into account in young people with a history of high energy trauma and elderly patients with a history of low-energy trauma and negative radiographs. The affected limb of these patients should be adequately immobilised and supported until the CT and/or MRI scans are completed.
Level of evidence: IV.