WHY DO X-RAYS SOMETIMES MISS FRACTURES?

After years of downhill skiing without injury, I started snowboarding last year. On my first attempt, I landed on my left foot and felt a sharp pain. Initially, the doctor believed there were no fractures since the X-ray came back negative. However, when my condition didn’t improve, further examination revealed a fragment of bone had broken off from the talus in my ankle. Why did the X-ray fail to detect this?

X-rays provide a two-dimensional view of bones, which can limit their ability to detect certain issues within the ankle joint. The talus bone is situated between the heel bone and the tibia (the lower leg bone), and it has two prominent bumps known as the medial and lateral processes. X-rays are only able to identify fractures of the lateral process in about 40 percent of cases.

When a fracture like this is missed, patients might be misdiagnosed with an ankle sprain and treated accordingly. Without improvement, they often return to the doctor with persistent pain and swelling, necessitating additional imaging to accurately diagnose the issue.

Reference:

Vincent A. Fowble, MD, et al. “Fracture of the Lateral Process of the Talus: A Report of 2 Cases.” The American Journal of Orthopedics, October 2004, Vol. 33, No. 10, pp. 522-525.