That is the question. Of course we’re no Prince Hamlet but we do have to make a wise decision on whether we should request an x-ray for a patient who has recently injured/sprained his foot, ankle or knee.
For feet or ankle joints. Quite simple. By Ottawa rules, as long as there is pain over these 4 areas when pressure is applied, do an x-ray.
- Posterior part of lateral maleolus.
- Posterior part of medial maleolus.
- Base of 5th metatarsal bone.
- Navicular bone.
If patient is unable to bear weight on the affected ankle joint, do an x-ray.
For knee joints. Only do an x-ray when:
- Patient is above 55 years of age.
- Tenderness over the patella and nothing else.
- Tenderness over head of fibula.
- Patient is unable to flex his knees to 90 degrees.
- Patient is unable to bear weight despite limping.
Then again, rules are rules. And rules are meant to be broken, when your life is at stake. Things don’t usually go the way you want it to be.
Patient: Hi Doc, morning. I want an x-ray.
Me: Morning. Er. Huh? What’s the x-ray for?
Patient: It’s for my knees. Can I get it done today?
Me: Wait wait wait. What’s wrong with your knees?
Patient: I have this pain in my knees.
Me: And how long has the pain been? Months? Any falls or injuries?
Patient: Just yesterday. Had a twitching pain in the right knee for a couple of secs. No fall what-so-ever. Thought might as well I get both x-ray’d since I’m here.
Me: I doubt you need an x-ray for that sort of ..
Patient: Why not? I personally took leave today so that I could come to have an x-ray done and you’re not giving it to me?! Are you going to be held responsible if anything happens to my knees?!
Just one of those daily nonsense I get during the usual jam-packed clinic sessions. Life ain’t as easy as you think it would be.