MISSED INJURIES OF THE MUSCULOSKELETAL SY STEM IN POLYTRAUMATIZED PATIENTS - A RETROSPECTIVE STUDY

In order to quantify frequency, localisation and consequences of misse d musculoskeletal injuries in multiple injured patients, 323 cases wer e retrospectively analyzed. 40 primarily missed injuries were found, 1 2 of them in patients, who had been transferred from another hospital. This rate of 12,4 % corresponds with the literature. Four regions are mainly affected: 1. the cervical spine, especially the cervicothoraci c transition, 2. the shoulder, 3. the ligaments of the knee especially with femur or tibia fractures at the same time, and 4. the forefoot. About half of the primary missed injuries are ligament lesions. Wherea s spine injuries were diagnosed within the first 2 weeks (average 4 da ys), ligament injuries (average 28 days) and foot injuries (average 38 days) were discovered at the patient's mobilization phase. Reasons fo r non detecting the injuries are: Missing or inadequate x-rays, not co nsistently continued diagnostic steps, inaccurate or not repeated clin ical examination, apparent insignificance of peripheral injuries in mu ltiple trauma. The potential danger of neurologic deficits of vertebra l fractures, delay of rehabilitation due to secondary correction surge ry (e.g. secondary ligament reconstructions) and imminent permanent da mage (e.g. posttraumatic foot deformities) show the importance of a qu ick diagnosis of all injuries, even those appearing at the first glanc e as unimportant.