It is possible to miss a neck fracture clinically as it isn't just
distracting injuries but distraction - being emotionally upset or
feeling very sick is enough of a stimulus.
The plain films very often do show an abnormality, but miss enough that
I have certainly got into several arguments lately, once with the
orthopaedic team but frequently with the Department for the Protection
of the Electron for CT. I always get a plain lateral. I have to say that
even the DFPE usually eventually agree to CT. Of course we enter an
entirely different minefield with the patient with a normal set of films
and severe pain on moving the neck - who can get an emergency MR in
those cases?
/Rowley./
> *From:* Adrian Fogarty <[log in to unmask]>
> *To:* [log in to unmask]
> *Date:* Mon, 30 Oct 2006 12:12:02 -0000
>
> Now perhaps that's worth a whole new thread on its own, and apologies
> to Peter for going off on a tangent, but how many of you go straight
> for CT in significant head traumas these days? And what is the
> evidence for this practice?
>
> Our radiologists mostly insist on at least a lateral plain film,
> arguing, quite reasonably to my mind, that 1) subtle malalignment is
> easier to visualise, 2) bony detail (i.e. trabecular detail) is
> completely lost on CT, and 3) CT slices can completely miss a subtle
> fracture that lies between slices.
>
> This means that we're now doing plain laterals on these patients more
> as a "routine" prior to their CT, as the lateral is unlikely to
> change our management, i.e. we're not about to "clear" someone's neck
> on the basis of plain films alone. OK, I haven't mentioned AP films
> but to my mind these add precious little to diagnosis in most neck
> injuries.
>
> I know of one unit that dispenses completely with plain films now,
> going straight for CT, but this might reflect the high quality of
> their latest scanner, together with the proximity of their scanner to
> their ED. Clearly this practice must be commonplace in the Antipodes.
>
> AF
>
> ----- Original Message -----
> From: "Howes, Marten" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, October 30, 2006 5:26 AM
> Subject: Re: Friday quiz
>
> why did you do a plain x-ray - with that mechanism I would have gone
> straight for CT?
>
> Marten
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