Missed Hind Foot Fractures: Worth a Second Look?

Purpose or Learning Objective: This pictorial review of multiple hindfoot fractures gathered at our department serves as an educational article as well as raising awareness about possible missed fractures in the hindfoot, focusing on their clinical and medicolegal importance. It is intended to help radiologists, emergency department physicians, and practitioners recognize subtle fractures of the hindfoot, thus reducing misdiagnosis rates and mitigating the associated medicolegal risks.

Methods or Background: Injuries related to the foot and ankle continue to be among the common presentations to emergency departments. We discuss the high frequency of foot and ankle injuries in emergency department settings, citing statistics that show a large number of cases related to sprains and fractures. Despite the reliance on plain radiographs as the first line of imaging, fractures are still commonly missed due to various pitfalls such as overlapping bones and difficulty in interpreting radiographs. We highlight the growing concerns over the financial implications of missed diagnoses, citing increased legal claims, damages, and the burden placed on the National Health Service. Using a case-based pictorial approach, we summarize the relevant anatomy, a variety of hindfoot injuries, and the relevant mechanisms and implications of each.

Results or Findings: Commonly missed fractures are those of the posterior and lateral processes of the talus, anterior process of the calcaneum, and other ossicle fractures. This case-based article outlines the relevant anatomy, the important mechanisms, and the implications of these fractures with a variety of examples. In addition to the serious consequences for patients, including prolonged recovery times and complications, missed hindfoot fractures present a significant financial cost to the health care system.

Conclusion: Missed hindfoot fractures present both clinical and financial challenges, with significant implications for patient care and health care resources. Advanced imaging techniques such as computed tomography and magnetic resonance imaging play a critical role in diagnosing these subtle fractures. The article underscores the importance of raising awareness among health care providers, especially trainees and less experienced staff, as well as providing examples and learning points to reduce the risk of missed diagnoses and mitigate the clinical and medicolegal consequences associated with delayed treatment.

Publikationsverlauf

Artikel online veröffentlicht:
02. Juni 2025