Bone scan as a screening test for missed fractures in severely injured patients

Lee, K.-J.; Jung, Kyoungwon; Kim, J.; Kwon, Junsik

doi:10.1016/j.otsr.2014.09.015

Cited by 9 publications

(10 citation statements)

References 16 publications

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“…From previous researches, rib fractures were identified in 7∼ 40% of multiple trauma cases [8][9][10][11] In conclusion, WBBS was useful for detecting missed bone injuries in patients with multiple traumas.…”

Section: Discussionmentioning

confidence: 77%

Whole Body Bone Scan for Detecting Missed Bone Injuries in Multiple Trauma Patients

Jeong

Kim

Choi

et al. 2017

JACS

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Patients with multiple traumas often experience multiple fractures that are missed or overlooked, despite the use of imaging, careful history taking, and physical examinations. This study aimed to evaluate the usefulness of whole body bone scan (WBBS) for detecting missed bone injuries in patients with multiple traumas. Methods: We evaluated 30 patients with multiple traumas who underwent WBBS at single tertiary referral center between March 2008 and February 2016. We assessed the association of patient demographics with WBBS uptake as a binomial outcome variable. Results: There were no significant differences in patient demographics by WBBS. The mean injury severity score did not differ by WBBS (18.1 in the WBBS-negative group vs. 18.4 in the WBBS-positive group), and duration from admission to the evaluation of the WBBS was similar (5.4 days in both groups). The most common uptake site in the WBBS was the ribs (n=7), followed by the tibia (n=3), skull (n=2), ankle (n=1), and sternum (n=1). None of the missed injuries required further treatment, such as manual reduction or surgery. Conclusion: WBBS was useful for detecting missed bone injuries in patients with multiple trauma.

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Section: Discussionmentioning

confidence: 77%

Whole Body Bone Scan for Detecting Missed Bone Injuries in Multiple Trauma Patients

Jeong

Kim

Choi

et al. 2017

JACS

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“…This report represents one of the first cases of “ de novo ” atraumatic pedicle insufficiency bilateral fractures without any pre-existing biomechanical risk factors. We believe this type of fracture is easily overlooked on plain radiographs if undisplaced, 21 thus justifying advanced modalities if suspected. It may be associated with subsequent development of lytic spondylolisthesis, though the strength of such an association is not clear.…”

mentioning

confidence: 93%

Spontaneous Atraumatic Bilateral Pedicle Insufficiency Fractures

Surur

Zeglinski-Spinney

Koussy

et al. 2018

Can. J. Neurol. Sci.

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“…Hence, there is a limitation of concomitantly evaluating the co-existing musculoskeletal injuries during the initial resuscitation and assessment. Previously, many studies have reported the missed bone fractures in polytrauma patients with high incidences [ 2 , 4 , 13 , 15 , 20 , 21 ]. However, there is a few studies specifically addressing the combined skeletal trauma in patients with traumatic brain injury (TBI) [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…A whole body bone scan (WBBS) is one of the useful diagnostic techniques to assess the multiple number of traumatic lesions in the whole skeletal system without invasive technique [ 5 , 13 ]. As mentioned earlier, the combined skeletal trauma in patients with TBI can be overlooked due to their altered neurologic states.…”

Section: Introductionmentioning

confidence: 99%

Missed Skeletal Trauma Detected by Whole Body Bone Scan in Patients with Traumatic Brain Injury

Seo

Whang

Pyen

et al. 2020

J Korean Neurosurg Soc

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Objective Unclear mental state is one of the major factors contributing to diagnostic failure of occult skeletal trauma in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the overlooked co-occurring skeletal trauma through whole body bone scan (WBBS) in TBI. Methods A retrospective study of 547 TBI patients admitted between 2015 and 2017 was performed to investigate their cooccurring skeletal injuries detected by WBBS. The patients were divided into three groups based on the timing of suspecting skeletal trauma confirmed : 1) before WBBS (pre-WBBS); 2) after the routine WBBS (post-WBBS) with good mental state and no initial musculoskeletal complaints; and 3) after the routine WBBS with poor mental state (poor MS). The skeletal trauma detected by WBBS was classified into six skeletal categories : spine, upper and lower extremities, pelvis, chest wall, and clavicles. The skeletal injuries identified by WBBS were confirmed to be simple contusion or fractures by other imaging modalities such as X-ray or computed tomography (CT) scans. Of the six categorizations of skeletal trauma detected as hot uptake lesions in WBBS, the lesions of spine, upper and lower extremities were further statistically analyzed to calculate the incidence rates of actual fractures (AF) and actual surgery (AS) cases over the total number of hot uptake lesions in WBBS. Results Of 547 patients with TBI, 112 patients (20.4 %) were presented with TBI alone. Four hundred and thirty-five patients with TBI had co-occurring skeletal injuries confirmed by WBBS. The incidences were as follows : chest wall (27.4%), spine (22.9%), lower extremities (20.2%), upper extremities (13.5%), pelvis (9.4%), and clavicles (6.3%). It is notable that relatively larger number of positive hot uptakes were observed in the groups of post-WBBS and poor MS. The percentage of post-WBBS group over the total hot uptake lesions in upper and lower extremities, and spines were 51.0%, 43.8%, and 41.7%, respectively, while their percentages of AS were 2.73%, 1.1%, and 0%, respectively. The percentages of poor MS group in the upper and lower extremities, and spines were 10.4%, 17.4%, and 7.8%, respectively, while their percentages of AS were 26.7%, 14.2%, and 11.1%, respectively. There was a statistical difference in the percentage of AS between the groups of post-WBBS and poor MS ( p =0.000). Conclusion WBBS is a potential diagnostic tool in understanding the skeletal conditions of patients with head injuries which may be undetected during the initial assessment.

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Bone scan as a screening test for missed fractures in severely injured patients

Abstract: Level IV, retrospective study.

Cited by 9 publications

References 16 publications

Whole Body Bone Scan for Detecting Missed Bone Injuries in Multiple Trauma Patients

Whole Body Bone Scan for Detecting Missed Bone Injuries in Multiple Trauma Patients

Spontaneous Atraumatic Bilateral Pedicle Insufficiency Fractures

Missed Skeletal Trauma Detected by Whole Body Bone Scan in Patients with Traumatic Brain Injury

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