Strategies to Reduce Missed Fracture Diagnoses: Insights from Medical Malpractice Cases in China

Missed fractures are a frequent source of malpractice claims in China. We reviewed 52 legal judgments (2021-2023) involving missed fractures to characterize the epidemiology, injury patterns, and diagnostic errors. Most patients were middle-aged males injured in traffic accidents. Lower extremity fractures accounted for over half of missed diagnoses, especially femoral neck (35.4%) and ankle/foot (16.7%). 85.4% were non-displaced fractures, often originally diagnosed in emergency departments. Physicians were found negligent in 63.5% of cases. Occult fractures are prone to underdiagnosis as soft tissue injuries. To reduce errors, physicians should thoroughly evaluate injury mechanisms, perform appropriate radiologic studies, immobilize when uncertain, and ensure follow-up. Quality improvement initiatives are needed to enhance fracture detection. Findings highlight the need for heightened suspicion and diligent radiographic assessment to avoid delayed or missed fracture diagnoses.