Omitted spinal X-ray examination after a fall from a height of 3 m

• Published in: Der Unfallchirurg 2016-02, Vol.119 (2), p.159-163
• Main Authors: Holzapfel, K, Schubert, E C, Huber-Wagner, S, Neu, J
• Format: Article
• Language: ger
• Subjects: Accidental Falls; Diagnostic Errors - legislation & jurisprudence; Diagnostic Errors - prevention & control; Expert Testimony - legislation & jurisprudence; Humans; Male; Malpractice; Middle Aged; Radiography, Thoracic; Spinal Fractures - diagnostic imaging; Spine - diagnostic imaging
• ISSN: 1433-044X
• DOI: 10.1007/s00113-015-0078-8

A 59-year-old patient with right-sided chest pains after a fall from a height of 3 m was referred to hospital by an emergency physician. The chest x-rays showed fractures of the third and seventh ribs on the right side. Inpatient analgesic therapy was initiated and after 3 days the patient was discharged from hospital for further outpatient treatment. As the pain persisted the patient consulted a surgeon 5 weeks later and the first X-ray examination of the spine was carried out which revealed the formation of several wedge-shaped thoracolumbar vertebral bodies. Further magnetic resonance imaging (MRI) diagnostics also revealed alterations to T10, T12, L1 and L3 as well as radiological signs of Scheuermann's disease; however, a definite statement differentiating these findings from older spinal fractures as a result of the accident was no longer possible. The patient claimed that the hospital failed to perform spinal X-ray investigations leading to prolonged pain and limitations in the quality of life. An external expert stated that the distracting injury of the ribs and the pain medication might have veiled the additional vertebral fractures. Thus, an earlier diagnosis of the apparently stable vertebral fractures would not have changed the conservative therapy approach. The decision of the arbitration board differed from the expert opinion as additional imaging techniques of the spine should have been initially performed due to the mechanism of injury. Although no irreversible damage to health resulted an earlier targeted treatment could have reduced the overall length of therapy.