Missed injuries, commonly referred to as “the trauma surgeon’s nemesis,” are an expected occurrence in the management of multiply injured patients. The definition of a missed injury is institution specific. Generally speaking, however, a missed injury is an injury identified at some defined time after the initial assessment. Missed injuries are not frequently life-threatening. However, depending on the exact circumstances, a missed injury may result in long-term disability. Moreover, missed injuries may complicate the relationship between the health care provider and his or her patient.

The initial assessment of a trauma patient consists of a primary and a secondary survey. The purpose of the primary survey is to simultaneously identify and initiate treatment of immediately life-threatening conditions. The secondary survey consists of a systematic, head-to-toe physical examination. A definitive care plan is established based on injuries identified in the initial assessment. Despite a carefully performed initial assessment, the incidence of missed injury is approximately 10%. The majority of missed injuries are musculoskeletal injuries, a large proportion of which are extremity injuries. The following conditions are associated with missed injuries in trauma patients: