DOUBLE TAKE - FRACTURE FISHING IN ACCIDENT AND EMERGENCY PRACTICE

Objective - To investigate conditions where, after initially negative plain x rays following trauma, there subsequently proves to be fractur e, and to explore ways in which the management might be improved. Desi gn - A 16 month prospective study. Patient details were collected from accident and emergency (A&E) review clinics and returns, A&E ward adm issions, correspondence from other services, and discussions at a week ly clinicoradiological conference. The inclusion criteria comprised A& E trauma patients with normal initial plain x rays and proven fracture s on subsequent imaging for the same patient event. Setting - A large A&E department seeing 65 000 new attendances per annum with full back up services. Results - 55 cases were identified: 41 fractures were ide ntified on subsequent plain x ray, six on bone scan, six on CAT scan, and two on MRI scan. The commonest regions involved were the wrist, pe lvis/hip, ankle/foot, and leg. Follow up had not been arranged at the initial attendance in 17 instances and between two and 135 days were r equired for definitive fracture recognition. All but nine patients req uired alteration in treatment because of fracture detection. Conclusio ns - Clinical suspicion of fracture at initial A&E attendance should p rompt organised follow up even in the face of normal plain x rays. Con sideration should be given to alternative imaging techniques which may have a higher resolution than plain x rays. Close corroboration betwe en A&E and radiology departments has benefits in patient care in this group of patients and may lead to a reduction in functional disability and litigation.