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  • Title: [Errors in the radiological diagnosis of injuries of the cervical spine (author's transl)].
    Author: Paakkala T, Keski-Nisula L, Lehtinen E.
    Journal: Rofo; 1978 May; 128(5):550-8. PubMed ID: 149063.
    Abstract:
    The frequency of fractures of the cervical spine has increased with the rise in traffic accidents, but the radiological diagnosis of fractures at the initial examination remains unsatisfactory. A false negative diagnosis in the accident department was made in 25 out of 86 patients (29%) by a surgeon and in 12 patients (14%) by a radiologist. Poor radiographic quality was an important source of error, particularly for the diffult fractures in the cranial and caudal parts of the cervical spine. Half the fractures of the arch of the atlas and of the odontoid were missed initially. There was also difficulty in diagnosing fractures of the articular processes, evulsion fractures of the vertebrae and unilateral subluxation. Since the late results of missed vertebral fractures may be fatal, it is necessary to make more use of those signs which may indicate a fracture. Widening of the pre-vertebral soft tissues was seen in 33 out of 100 patients and an increased distance between articular facets on the A. P. projection in 19 out of 100 patients. Angled A. P. projections are useful for the diagnosis of fractures of articular facets in bed-ridden patients. Fractures in the lower cervical spine are well seen on oblique supine views. In larger accident departments, tomography and immediate radiological consultation should be available.
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