Missed Fractures in Children

Background:Missed fractures and their potential serious long-term consequences are common in pediatric trauma patients despite complete evaluation with standard trauma protocols.Methods:MEDLINE was searched up to April 2019. All study about missed fracture in children were included.From 4629 screened citations, 55 were strictly focused on the missed fracture in children were selected and reviewed.Results:Several factors such as patient-related, clinical, technical, and radiological causes contribute the problem but the most important of which is a junior radiologist’s (or junior physician’s) lack of expertise in child skeletal injuries.The incidence of missed fractures ranging from 2% to 18%. Risk of missed fractures in children increased due to immaturity of skeleton and increased bone plasticity, presence of growth plate, nondisplaced physeal injury and presence of large radiolucent structures around the joints.Occasionally several factors are responsible for missed fractures (30% of cases). The most commonly locations of missed fracture in children are hand, elbow, radius, knee and pelvis. Several preventive measures can reduce the risk of missing fractures such as standard protocol of examination and radiologic assessment of multiple trauma children, extended tertiary survey and repeated examination of children, additional imaging when the primary results are doubtful, comparative imaging of normal contralateral side, CT Scan or MRI in unconscious children.Conclusion:In spite of above mentioned methods, regular retrograde review of missed cases, annual assessment of programs and improvement of education of staff is crucial to decrease the incidence of missed fractures.