[Missed injuries of the musculoskeletal system in multiple trauma--a retrospective study]

In order to quantify frequency, localisation and consequences of missed musculoskeletal injuries in multiple injured patients, 323 cases were retrospectively analyzed. 40 primarily missed injuries were found, 12 of them in patients, who had been transferred from another hospital. This rate of 12.4% corresponds with the literature. Four regions are mainly affected: 1. the cervical spine, especially the cervicothoracic transition, 2. the shoulder, 3. the ligaments of the knee especially with femur or tibia fractures at the same time, and 4. the forefoot. About half of the primary missed injuries are ligament lesions. Whereas spine injuries were diagnosed within the first 2 weeks (average 4 days), ligament injuries (average 28 days) and foot injuries (average 38 days) were discovered at the patient's mobilization phase. Reasons for non detecting the injuries are: Missing or inadequate x-rays, not consistently continued diagnostic steps, inaccurate or not repeated clinical examination, apparent insignificance of peripheral injuries in multiple trauma. The potential danger of neurologic deficits of vertebral fractures, delay of rehabilitation due to secondary correction surgery (e.g. secondary ligament reconstructions) and imminent permanent damage (e.g. posttraumatic foot deformities) show the importance of a quick diagnosis of all injuries, even those appearing at the first glance as unimportant.