Diagnosis of occult fractures and dislocations

The principles to be followed in the identification of occult injuries include: a good history and physical examination to arouse a high index of suspicion; high quality radiographs; radiographs of the whole bone and associated joints above and below, particularly in the lower cervical spine and hip; special views to delineate fractures, particularly oblique films, tangenital and axial views and stress films. Tomograms may also be helpful; follow-up and re-check films, especially with fractures and epiphyseal injuries. With early identification of fractures that are commonly missed, these injuries eventually cease to be occult and appropriate management can be instituted.