When should X-rays be obtained in patients with suspected MSK trauma?

Obtaining X-rays in patients with suspected musculoskeletal (MSK) trauma is crucial for a proper assessment and management plan. When tenderness associated with bony deformity is present, it is indicative of a possible fracture or significant injury to the bone. In such cases, X-rays are essential for confirming the presence of any fractures, determining the alignment of bony structures, and evaluating the extent of injury.

The presence of tenderness and bony deformity typically suggests that further imaging will guide clinical decisions regarding stabilization, surgical intervention, or other therapeutic options. X-rays serve as the first-line imaging modality for evaluating bone integrity and are relatively quick to perform, making them invaluable for initial assessment in trauma cases.

Other scenarios, such as a request from an orthopedic surgeon or cases where CT imaging has already been performed, do not make X-rays unnecessary; rather, they serve different roles in the decision-making process. The mere observation of soft tissue swelling does not automatically necessitate X-rays unless there are additional signs of bony involvement, such as tenderness or deformity. Thus, the presence of tenderness associated with bony deformity is the key indicator for obtaining X-rays in suspected MSK trauma.