MSK Injuries – X-Ray Pitfalls

ED Rounds – June 2019

Dr. George Xidos

  • 10-20% of ED visits are for musculoskeletal injuries
  • Unfortunately, most common cause of litigation in Canada
  • Pitfalls include missed injuries, failure to recognise
  • significance of injuries, inadequate initial management, and
  • failure to refer to appropriate specialists in a timely manner


● Complete hx : mechanism of injury, age, risk factors

● Accurate physical (e.g. there is more to the wrist exam than checking the “snuffbox” and more to the ankle exam than included in the Ottawa rules)

● X ray studies:

○ 20% of MSk litigation involves failure to order X rays in the first place

○ Ensure adequate quality of films (e.g. proper lateral views of hands, wrists and elbows) and order additional views if required

○ Be acutely aware of common locations for occult fractures: scaphoid, radial head, hip, talar dome, tibial plateau etc.

○ Most commonly missed fracture is the second fracture.


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