Undetected injuries in head-injured adults

Of 254 adults admitted over a period of two years to the Head Trauma Service, 29 (11%) had ten previously undiagnosed fractures and/or dislocations and 29 had previously undetected peripheral neuropathies. The average delay in diagnosis was 57 days. Only one fracture, a fracture-dislocation of the thoracic spine, was of major consequence. Median, ulnar, and peroneal neuropathies were common and were usually associated with other orthopedic injuries. Nine of the neuropathies were explored and normal neurologic recovery ensued in each case. Nerve function, commonly the peroneal, did not return in six patients. This retrospective knowledge of head injured patients is necessary for early diagnosis and possible prevention of these neuropathies.