UNDIAGNOSED FRACTURES IN SEVERELY INJURED CHILDREN AND YOUNG-ADULTS

A whole-body bone scan was performed to search for undetected fracture s in forty-eight patients who had multiple injuries or a head injury, or both, and who were less than twenty-two years old. The study took p lace from January 1991 to July 1992. Radiographs had been made of all areas of suspected skeletal trauma at the time of admission. Follow-up plain radiographs were made of all areas where unexpected abnormal tr acer activity was noted. Forty-two of these areas were noted in eighte en skeletally immature patients and fifty-two, in twelve skeletally ma ture patients. Nineteen previously unrecognized fractures were identif ied in the subsequent radiographic analysis. Four skeletally immature and two skeletally mature patients had an alteration in treatment on t he basis of the identification of a previously undiagnosed injury. Eac h of these six patients had a cast applied. A fracture was identified three weeks or more after the injury in two skeletally mature patients . These fractures would have been treated (one with a cast and the oth er with open reduction and internal fixation) if they had been diagnos ed earlier. We believe that this analysis demonstrates the usefulness of technetium radionucleotide bone-imaging, as an adjuvant to the orth opaedic examination, in the identification of undiagnosed musculoskele tal injuries in a patient who is less that twenty-two years old and wh o has sustained a head injury or multiple injuries, or both.