Delay in diagnosis of thoracolumbar fractures

Aso-Escario, José; Sebastián, C. García; Vizán, Alberto Aso; Martínez-Quiñones, José Vicente; Consolini, Fabián; Arregui, Ricardo

doi:10.4081/or.2019.7774

Cited by 11 publications

(6 citation statements)

References 31 publications

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“…Axial fractures may be associated with unspecific symptoms and diagnostic delay, and many are not diagnosed. 38,39 In spite of this, the risk was elevated in pITP. Patients with pITP are often in a hospital follow-up, and therefore health events, such as a fracture, are more likely to be captured.…”

Section: Discussionmentioning

confidence: 99%

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Risk of fractures and use of bisphosphonates in adult patients with immune thrombocytopenia—A nationwide population‐based study

Mannering,

Hansen,

Moulis

et al. 2024

Br J Haematol

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SummaryCorticosteroids remain the first‐line treatment of immune thrombocytopenia (ITP), but increase the risk of osteoporosis and fractures. Bisphosphonates are used for the treatment of osteoporosis, but their usage among patients with ITP has not been systemically described. We investigated the risk of fractures and the use of bisphosphonates in adult patients with primary (pITP) and secondary ITP (sITP) compared with matched comparators in a nationwide registry‐based cohort study. We identified 4030 patients with pITP (median age 60 years [IQR, 40–74]), 550 with sITP (median age 59 years [IQR, 43–74]) and 182 939 age–sex‐matched general population comparators. All individuals were followed for incident fractures. Bisphosphonate use was estimated for calendar‐years and in temporal relation to the ITP diagnosis. Adjusted cause‐specific hazard ratio (csHR) for any fracture was 1.37 (95% confidence interval [CI] 1.23; 1.54) for pITP and 1.54 (1.17; 2.03) for sITP. The first‐year csHR was 1.82 (1.39; 2.40) for pITP and 2.78 (1.58; 4.91) for sITP. Bisphosphonate use over calendar‐years and in the early years following ITP diagnosis was higher among patients with ITP diagnosis compared with the general population. In conclusion, the risk of fractures and the use of bisphosphonates are higher in patients with ITP compared with the general population.

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Section: Discussionmentioning

confidence: 99%

“…However, fractures treated at an ER are still recorded correctly with updated codes after discharge, but these data were only available from 1994 and onwards. Axial fractures may be associated with unspecific symptoms and diagnostic delay, and many are not diagnosed 38,39 . In spite of this, the risk was elevated in pITP.…”

Section: Discussionmentioning

confidence: 99%

Risk of fractures and use of bisphosphonates in adult patients with immune thrombocytopenia—A nationwide population‐based study

Mannering,

Hansen,

Moulis

et al. 2024

Br J Haematol

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“…The incidence of misdiagnosed spine fractures varies among studies and ranges from 19.5% to 45%. [23] Burns et al was able to detect, localize, classify vertebral spine fractures as well as measure bone density of vertebral bodies using lumbar and thoracic CT images. Achieved sensitivity was 95.7% and a false-positive rate of 0.29 per patient for compression fractures detection and localization.…”

Section: Upper Limbs Fracturesmentioning

confidence: 99%

Artificial intelligence application in bone fracture detection

Al-Ghaithi¹,

Maskari²

2021

J Musculoskelet Surg Res

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Bone fractures are among the most common causes of emergency department visits. Diagnostic errors often occur due to misinterpretation of radiological examination, which may lead to the delayed treatment and poor outcomes. [1] The analysis of causes of fracture diagnostic inaccuracies has found them to be multifactorial, including physician factors, image quality, insufficient clinical information, fracture type, and polytrauma. [2] Four out of five diagnostic errors in an emergency settings are due to physician factors, yet radiographs are often interpreted by clinicians who lack the required specialized expertise. [3] Even with an experienced radiologist, physician fatigue and error may increase during a long busy day, increasing the risk of missing a subtle fracture. [4] Thus, a model that can offer assistance to physicians presenting second opinions through highlighting concerning areas in imaging examination may produce more efficient interpretation, standardize quality, and decrease errors. With recent advances in deep learning (DL) and computer vision, artificial intelligence (AI) may play a significant role in this field.AI is a powerful technology that has demonstrated good potential at radiographic image interpretation. While earlier levels of AI performance were subhuman, modern versions are able to match or even surpass humans' performance. [5] AI has also shown promising results in complex diagnostics in other medical specialties such as ophthalmology, dermatology, and pathology. [6] The aim of this article is to explore the potential of utilizing AI in fracture diagnosis by reviewing the current literature on this subject. technIcal aspectsAI, machine learning (ML), DL, and convolutional neural networking (CNN) are terminology, which often used interchangeably [Figure 1]. AI refers to any skill where a machine performs tasks that mimic human intelligence. ML is a subfield of AI that enables a machine to learn and improve from the experience independently of human action. DL is a more specialized subfield of ML, which can analyze more data sets transforming the inputs of an algorithm into outputs using

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“…Fracture-dislocation of the thoracic spine is usually caused by a high-velocity impact and can lead to spinal cord injury. The incidence of misdiagnosis varies in many studies, ranging from 19.5% to 36% [ 1 ]. Neglected fracture-dislocation thoracic spine without neurological deficit is an extremely rare injury.…”

Section: Introductionmentioning

confidence: 99%

Corrective osteotomy of global sagittal imbalance in the neglected fracture-dislocation thoracic spine

Bunmaprasert

Chaibhuddanugul

Keeratiruangrong

et al. 2021

Trauma Case Reports

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Background Neglected fracture-dislocation thoracic spine without neurological deficit is an extremely rare injury. Current studies reveal that global sagittal balance is very important for quality of life (QOL). Complex deformity causes difficulty with dissection in the surgical planning and type of spinal osteotomy. Restoration of global balance parameters are related to a successful outcome, if the surgeon understands the morphology of complex bone deformity and the surgical tactics of spinal osteotomy. Case presentation A 23-year-old female presented with untreated thoracic kyphotic deformity without paraplegia (ASIA E), following a motor vehicle accident 2 months earlier. Radiographic imaging and computed tomography scan revealed a complex fracture-dislocation at the T8–T9 level with kyphosis deformity, abnormal C7 plump line, and 65 degrees of sagittal Cobb's angle (T7–T11). The multilevel Ponte osteotomy surgical technique was performed at the apex of the kyphosis. After the patient underwent corrective osteotomy and instrumentation, postoperative radiograph and CT scan revealed 24 degrees of sagittal Cobb's angle (T7–T11). The patient's balance was recovered when followed up at 1 year. The patient's quality of life was improved and thus she was extremely satisfied with this treatment. Conclusion Neglected fracture-dislocation thoracic spine without neurological deficit is rarely seen. It is a complex deformity injury. In this case, we performed multilevel Ponte osteotomy, instead of osteosynthesis, to restore the complex deformity that was affecting global balance. Successful outcomes are the result of good surgical preoperative planning and the surgical tactics of spinal osteotomy.

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Delay in diagnosis of thoracolumbar fractures

Cited by 11 publications

References 31 publications

Risk of fractures and use of bisphosphonates in adult patients with immune thrombocytopenia—A nationwide population‐based study

Risk of fractures and use of bisphosphonates in adult patients with immune thrombocytopenia—A nationwide population‐based study

Artificial intelligence application in bone fracture detection

Corrective osteotomy of global sagittal imbalance in the neglected fracture-dislocation thoracic spine

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