As a rule, we used to X Ray almost everything when it hurt. This was a smart precaution, because if there is a fracture in a region, we want to get that taken care of immediately! But, other than finding fractures, there are very limited reasons to take an X Ray for most acute injuries, and they often will not tell your doctor much at all that can help you or them other than that a fracture is not there (but what they will do is cost you or your insurance a pretty penny). So, as doctors became better at screening for fractures and ruling them out, X Rays became less and less common because other physical examination features were far more useful to them in helping you. But, it now seems like your doctor is ignoring something that once was very important! So, how do we decide if your knee or ankle, two of the most common joints that used to be X Rayed, need it?
Enter the Pittsburg Knee and Ottawa Ankle Rules! Named for the cities in which their research was performed, these methods ask some simple questions that can more easily rule you out of needing a fracture.
For your knee: are you below 12 or above 50 years old? Did the injury begin immediately after a blunt force injury or a fall? Are you unable to take at least 4 steps (limping or otherwise)? If you answered “No” to all of these questions, your physician can usually rule out an X Ray right away!
For your ankle: do you have pain directly on the tip of the lateral malleolus (the large bump on the outside of your ankle) or along the back of the medial malleolus (the same bone on the inside of the foot)? Do you have pain directly on the bones of the mid foot (the line across your foot that transects between your ankle and toes)? After the injury and right now, are you unable to put any weight on the ankle at all? If we are able to say “No” to all of these, again we can usually rule out an X Ray to the foot!
With a “Yes” to any one of these, you physician may ask more detailed questions, or send you straight to radiology depending on what other findings their exam turns up (because obviously just being 51 and having knee pain does not mean you have a fracture!) but not sending you often just means that your physician is a good listener! Rules like this are being developed as well for radiology for various body parts in order to save our patients time, money, and radiation exposure! It turns out, not sending you for imaging does not mean your doctor didn’t care at all! It often means they are paying close attention to little details, and care very very much!