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Missed Fractures in Severely Injured Patients
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À¯À缺(Yoo Jae-Sung) - ´Ü±¹´ëÇб³ ÀÇ°ú´ëÇÐ ´Ü±¹´ëÇб³º´¿ø Á¤Çü¿Ü°úÇб³½Ç
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Abstract
¸ñ Àû: ÁßÁõ ¿Ü»ó ȯÀÚ¿¡¼ Áö¿¬ Áø´ÜµÈ °ñÀýÀÇ Á¾·ù¿Í ¿øÀÎ, Áø´Ü¹æ¹ý ¹× óġ¿¡ ´ëÇØ ¾Ë¾Æº¸°íÀÚ ÇÑ´Ù.
´ë»ó ¹× ¹æ¹ý: 2001³â 1¿ùºÎÅÍ 2012³â 5¿ù±îÁö ´Ü±¹´ëÇб³º´¿ø ÀÀ±Þ½Ç¿¡ ³»¿øÇÑ 20¼¼ ÀÌ»óÀÇ ¼ºÀο¡¼ Injury Severity Score 16 ÀÌ»óÀÇ ÁßÁõ ¿Ü»ó ȯÀÚ 4,643¸í Áß °ñÀýÀÇ Ãʱâ Áø´Ü¿¡ ½ÇÆÐÇÏ¿´´ø 58¸í, 62¿¹ÀÇ °ñÀýÀ» ´ë»óÀ¸·Î ÇÏ¿´´Ù. µ¿¹Ý ¼Õ»óÀÇ Á¾·ù, °ñÀýÀÇ À§Ä¡, Áø´Ü¹æ¹ý, Ãʱâ Áø´Ü¿¡ ½ÇÆÐÇÏ¿´´ø ÀÌÀ¯¿¡ ´ëÇØ Á¶»çÇÏ¿´´Ù.
°á °ú: ÃÑ 62¿¹ÀÇ Ãʱâ Áø´Ü¿¡ ½ÇÆÐÇÑ Áø´Ü Áß Ã´Ãß °ñÀý 8¿¹, °ß°üÀý ÁÖÀ§ °ñÀý 10¿¹, »óÁö °ñÀý 8¿¹, °ñ¹Ý ¹× ºñ±¸ °ñÀý 10¿¹, ÇÏÁö °ñÀý 26¿¹¿´´Ù. µ¿¹Ý ¼Õ»óÀº µÎºÎ ¼Õ»óÀÌ 23¿¹·Î °¡Àå ¸¹¾ÒÀ¸¸ç, Áö¿¬ Áø´Ü ¹æ¹ýÀ¸·Î´Â ¹æ»ç¼±ÀÇÇÐ Àü¹®ÀÇÀÇ Æǵ¶¿¡ ÀÇÇÑ °æ¿ì°¡ °¡Àå ¸¹¾Ò°í, Ãʱâ Áø´Ü¿¡ ½ÇÆÐÇÑ ¿øÀÎÀ» »ìÆ캸¸é ¹æ»ç¼± °Ë»ç°¡ ÀûÀýÇÏÁö ¾Ê°Å³ª °ñÀýÀ» ¹ß°ßÇÏÁö ¸øÇÑ °æ¿ì°¡ °¡Àå ¸¹¾Ò´Ù.
°á ·Ð: ÁßÁõ ¿Ü»ó ȯÀÚ¿¡¼ °ñÀýÀÇ Ãʱâ Áø´Ü ½ÇÆи¦ ¹æÁöÇϱâ À§Çؼ´Â ¸é¹ÐÇÑ ÀÌÇÐÀû °Ë»ç¸¦ ÅëÇØ °ñÀýÀ» ÀǽÉÇÏ´Â °ÍÀÌ ¿ì¼±½ÃµÇ¾î¾ß ÇÒ °ÍÀ̸ç, ÀûÀýÇÑ ¿µ»ó Æò°¡¸¦ À§Çؼ´Â Á¤È®ÇÑ ¿µ»óÀ» ¾ò´Â °ÍÀÌ Áß¿äÇÒ °ÍÀÌ´Ù. ƯÈ÷ °ñÀýÀÌ ¹ß°ßµÈ °æ¿ì µ¿Ãø »óÁö ¶Ç´Â ÇÏÁöÀÇ ´Ù¸¥ °ñÀýÀÇ Æò°¡¿¡ ´õ¿í ÁÖÀǸ¦ ±â¿ï¿©¾ß ÇÒ °ÍÀÌ´Ù.
Purpose: The purpose of this study is to analyze anatomic distributions, diagnostic methods, and prognosis of missed fractures in patients with severe injury.
Materials and Methods: A review of single-institutional medical records between January 2001 and May 2012 identified 58 patients with 62 delayed diagnoses of fractures among 4,643 severely injured patients older than 20 years with Injury Severity Scores higher than 16. We evaluated combined injuries, location of fractures, diagnostic methods, and reasons for missed diagnosis at initial exam.
Results: Among 62 missed fractures, there were eight cases of spine fracture, 10 cases of peri-shoulder joint fracture, eight cases of upper extremity fracture, 10 cases of pelvis of acetabulum fracture, and 26 cases of lower extremity fracture. Head injury was the most common concomitant injury (23 cases). Initially missed fractures were most commonly discovered by official reading by radiologists. The most common reasons for misdiagnosis were the use of improper radiologic study and missed-reading of proper radiologic studies.
Conclusion: In order to prevent misdiagnosis of fractures in patients with severe injury, meticulous physical examination with suspicion of fractures should come first. In addition, obtaining proper radiologic study and thorough evaluation of radio-logic images are important to decreasing the rates of missed fracture diagnoses. In addition, thorough surveillance for ipsi-lateral fractures is important in extremities with identified fractures.
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ÁßÁõ ¿Ü»ó ȯÀÚ, °ñÀý, Áö¿¬ Áø´Ü
Severely injured patient, Fracture, Missed fracture
KMID :
0386420140270020113
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