[Fractures easily missed by conventional radiographic diagnosis]

Although conventional radiography is the mainstay for diagnosing fractures, there are multiple conditions in which a fracture can be overlooked by the radiologist. This report focuses on the radiographic findings of various presentations of fractures including (1) minimally displaced fractures, (2) avulsion fractures, (3) stress fractures, (4) incomplete fractures and physeal injuries in children, and (5) occult fractures complicated with overt injury. Radiologists need to be familiar with these relatively common entities and aware of the limitations of radiography for fracture diagnosis; there are cases that can be diagnosed clinically without radiographic findings of cortical disruption. Repeated radiographic examination, CT, or MRI may be indicated depending on the clinical situation. The involvement of radiologists in the routine interpretation of conventional radiographs in trauma settings is encouraged to improve the detection of subtle fractures.