Missed clavicle fractures on anterior-posterior views of skull X-rays: a retrospective, observational, and descriptive study

OBJECTIVE The clavicle is almost always seen in skull X-rays of infants. The objectives of this study were to determine how often the clavicle and clavicle fractures are visible but missed on the skull anterior-posterior view (skull AP) of infants and which factors are associated with missing the diagnosis. METHODS We retrospectively studied patients aged 1 year or younger who had a skull AP taken for any injury survey at a single urban, academic hospital between April 1999 and July 2012. Outcomes of interest were the numbers and percentages of visible clavicles; clavicle fractures, including missed ones on skull AP; and the factors associated with missing the diagnosis of a clavicle fracture. RESULTS Both clavicles were visible in 734 patients (89.6%). Of these, 10 patients (1.4%) had confirmed clavicle fractures, and 6 patients (0.8%) had fractures that were missed at presentation. Although we tried to determine the factors that might be associated with missed diagnoses, including age <6 months, male sex, blocking by guardian's hands, associated skull fractures, and mechanism of injury, none was significantly associated with missed clavicle fractures. CONCLUSION The clavicles were recognizable on skull X-rays in most cases. Therefore, one should check the clavicles when reading skull X-rays.