ED Pathway for Evaluation/Treatment of Child with a Suspected Extremity Fractures

Radiographic Views for Identifying Fractures by Location

MD/PNP X-RAY ORDERING GUIDELINES FOR EXTREMITY TRAUMA

LOCATION STANDARD COMMENTS
ELBOW 2 views
  • Add oblique
FOREARM 2 views
  • Includes wrist, elbow
  • Order separate wrist and elbow xrays:
    • Concern for fracture and 2 view is negative
    • If only 1 forearm bone broken
WRIST 3 views
  • Does not include the hand
  • 2 view only for foreign body or post-reduction
  • Displaced wrist: Obtain elbow and hand xrays
  • Concern for scaphoid fx – obtain scaphoid view
HAND 3 views
  • Includes wrist but just very distal radius and ulna
  • Obtain separate wrist views if concern for fracture
  • 2 view only for foreign body or post-reduction
FINGER 3 views
  • Specify digit
  • Multiple digits: order hand and specify which digits need lateral
SHOULDER 3 views
  • Standard: AP (internal and External rotation) and Y view
  • Axillary or Velpeau view, single views, order separately
KNEE 2 views
  • Tunnel view (tibial spine or eminence fracture) separate view
TIB/FIB 2 views
  • Includes ankle and knee, but mortise is not seen fully seen
  • Obtain separate ankle xrays if concern for ankle injury
  • Obtain oblique if concern for Toddler’s Fracture and 2 view is negative
ANKLE 3 views
  • Includes base of 5th metatarsal
FOOT 3 views
  • Obtain if any concern of fracture more distal to the ankle joint