You’ve rolled an ankle, fallen onto your wrist or watched your child take a hard knock on the sporting field. It hurts, it might be swollen and brusied and now you’re wondering:

Do we need an X-ray?

Not every injury needs imaging. Many sprains, strains and other soft-tissue injuries can be assessed without an X-ray. However, an X-ray may be recommended when the mechanism of injury, symptoms and clinical examination suggest that a bone may be fractured or another injury requiring imaging is suspected.

The difficulty is that you can’t always tell whether a bone is broken just by looking at the injury.

If you’re unsure, having the injury assessed can help determine whether an X-ray is actually necessary and what should happen next.

What does an X-ray show after an injury?

X-rays are particularly useful for looking at bones and joints.

After an acute injury, an X-ray may help identify:

• a broken or fractured bone;
• where a fracture is located;
• whether the pieces of bone remain in an appropriate position;
• some joint dislocations; and
• other changes involving the bones or joints.

However, an X-ray doesn’t show every type of injury.

Ligaments, tendons, muscles and other soft tissues generally aren’t assessed as well with standard X-rays. Depending on the suspected injury, other imaging such as ultrasound, CT or MRI may sometimes be considered instead.

The important question isn’t simply “Should I get an X-ray?”

It’s:

“What do we think is injured, and is an X-ray the right investigation for it?”

What are the signs that an injury might need an X-ray?

There isn’t one symptom that automatically means you need an X-ray.

A health professional considers the way the injury happened together with your symptoms and clinical examination.

Some findings that may increase concern about a fracture include:

• significant tenderness directly over a bone;
• difficulty putting weight through the injured area;
• difficulty using the injured arm, hand, wrist or finger normally;
• substantial pain following trauma;
• swelling or bruising;
• reduced movement;
• an unusual appearance or deformity; or
• an injury mechanism capable of causing a fracture.

Does lots of swelling mean I need an X-ray?

Not necessarily.

Both fractures and soft-tissue injuries can cause considerable swelling. A badly sprained ankle, for example, may swell dramatically without being fractured.

Swelling is therefore one piece of the clinical picture rather than a diagnosis by itself.

Does bruising mean a bone is broken?

No. Bruising can occur with both fractures and soft-tissue injuries.

Its location and extent may provide useful information during an assessment, but bruising alone can’t tell you whether you have broken a bone.

If I can move it, do I still need an X-ray?

Potentially.

Being able to move an injured body part does not rule out a fracture.

Some stable or non-displaced fractures still allow considerable movement. The same applies to walking. Being able to put some weight through an injured foot or ankle doesn’t necessarily mean there isn’t a fracture.

Does my child’s injury need an X-ray?

Children fall over, collide with other players and hurt themselves all the time, which can make deciding when an injury needs further investigation particularly difficult.

If your child has hurt their wrist, finger, ankle, foot or another area during sport or play, not every injury automatically needs an X-ray. In most cases injuries such as a fracture, especially if you’re not even sure if it is a fracture or more of a sprain, are not medical emergencies and therefore a visit and long wait at hospital emergency is unnecessary.

However, an assessment by a health professional may be worthwhile when your child has:

• significant pain or tenderness over a bone;
• difficulty using the injured limb normally;
• difficulty walking or putting weight through an injured leg;
• considerable swelling or bruising;
• reduced movement;
• an obvious change in appearance;
• pain that isn’t settling as expected; or
• an injury significant enough that you’re concerned something may be broken.

Children can also sometimes continue playing, walking or moving an injured area despite having sustained a fracture.

So “they can still move it” isn’t enough to rule one out.

Why can fractures in children sometimes be difficult to recognise?

Children’s bones aren’t simply smaller versions of adult bones. They are still growing and can sustain certain types of injuries that differ from those seen in adults.

Children also vary enormously in how they respond to pain. One child may immediately stop using an injured arm, while another may want to get straight back onto the field.

This means it’s important to consider the mechanism of injury, exact location of tenderness, swelling, movement and function, rather than relying only on how much pain your child reports.

Does an ankle injury need an X-ray?

Not every rolled or injured ankle needs imaging.

Ankle sprains are extremely common and many don’t require an X-ray. However, certain findings including the location of bony tenderness and ability to bear weight, can increase suspicion of a fracture.

Health professionals can use established clinical decision-making criteria alongside their examination to help determine whether imaging may be appropriate.

If you can’t comfortably put weight through the ankle, have significant bony tenderness, substantial swelling or are unsure how significant the injury is, consider having it assessed.

Does a wrist injury need an X-ray?

A fall onto an outstretched hand is a common cause of wrist injuries in both children and adults.

Depending on the mechanism and examination findings, this can cause anything from a relatively minor soft-tissue injury to a fracture.

Persistent or significant pain, swelling, difficulty using the hand or wrist and tenderness over particular areas of bone are all reasons to consider assessment.

An X-ray may then be recommended if a fracture is suspected.

Does a finger injury need an X-ray?

Jarred fingers are another classic sporting injury where it can be difficult to distinguish a sprain from a fracture.

Pain, swelling and bruising can occur with both and because our hands are constantly in use the pain level with even a minor injury can seem worse so none of these symptoms are particularly reliable when it comes to knowing how bad the injury really is.

An X-ray may be appropriate when examination suggests a fracture, particularly where there is significant bony tenderness, altered alignment or difficulty using the finger normally.

Due to the complexity of the hand and fingers with all their ligament and tendon attachments, even tiny fractures can require more thorough assessment and specific management to ensure full healing and hand function result. 

Can a physiotherapist tell me whether I need an X-ray?

Yes. Physiotherapists are trained to assess musculoskeletal injuries and identify findings that may indicate a fracture or another injury requiring further investigation. In relation to fractures, Physiotherapists who have trained and worked in fracture clinic and acute care settings are some of the best health professionals to assess and manage your injury.

An acute injury assessment can include looking at:

• how the injury happened;
• where you’re experiencing pain;
• areas of bony and soft-tissue tenderness;
• swelling and bruising;
• joint movement;
• strength and function;
• ability to walk or bear weight; and
• other relevant clinical findings.

Based on the assessment, your physiotherapist can determine whether imaging or another referral may be appropriate.

Can a Physiotherapist Refer for an X-ray in Australia?

Yes. A physiotherapist can refer a patient for X-rays in Australia when imaging is clinically indicated.

However, there can be differences in Medicare rebates and bulk-billing arrangements depending on the type of X-ray, who has requested it and the imaging provider. This means that imaging may sometimes attract an out-of-pocket cost. Imaging providers ultimately determine their own fees and whether an eligible service will be bulk billed.

At Activate Physiotherapy, we’ve established imaging pathways to make this process as straightforward as possible for our patients. When one of our physiotherapists assesses an injury and determines that an X-ray is appropriate, we can refer for the required X-ray through our imaging partner, with X-rays referred through this pathway bulk billed for eligible Medicare patients.

If the injury requires more advanced investigation, our team also works closely with a network of orthopaedic specialists. Where appropriate, we can help facilitate access to further imaging such as MRI through specialist referral pathways, or streamline referral directly to an orthopaedic specialist for further assessment and a surgical opinion when required.

This means that if you come to Activate with a suspected fracture, our role isn’t simply to tell you that you may need an X-ray. We can help coordinate the next steps — from assessment and imaging through to appropriate fracture management, specialist referral and rehabilitation.

If a fracture is confirmed and is suitable for physiotherapy-led management, you can learn more about how we manage these injuries through our Private Fracture Clinic in Brisbane.

When should I go straight to hospital after an injury?

Some injuries require urgent medical attention rather than routine physiotherapy or fracture-clinic assessment.

Seek urgent medical care for injuries involving things such as:

• a bone protruding through the skin or a significant open wound;
• obvious severe deformity;
• significant trauma;
• concerning loss of sensation;
• signs of compromised circulation;
• severe uncontrolled pain;
• suspected significant head, neck or spinal injury; or
• other symptoms suggesting a medical emergency.

For musculoskeletal injuries that don’t require emergency hospital care, management in the community in a fracture clinic or acute care clinic is often a faster and more efficient way to receive appropriate care for your injury and allows the health professionals in emergency to concentrate on more severe or life-threatening cases.

Not sure whether your injury needs an X-ray?

You don’t necessarily need to work that out for yourself.

If you or your child has sustained an acute musculoskeletal injury, an assessment can help determine what may have been injured, whether imaging is indicated and what you should do next.

Activate Physiotherapy provides acute injury and suspected fracture assessment at our Tingalpa and Stafford clinics in Brisbane.

Frequently Asked Questions About X-rays After an Injury

These are particularly important for the AISEO component.

How do I know if I need an X-ray after an injury?

You can’t always determine this from symptoms alone. The mechanism of injury, location of tenderness, swelling, movement, function and ability to bear weight can all help determine whether a fracture is suspected and an X-ray may be appropriate.

Do I need an X-ray if I can still move the injured area?

Possibly. Being able to move an injured body part doesn’t rule out a fracture. Some fractures still allow movement and even some weight-bearing.

Does my child need an X-ray after a sports injury?

Not every children’s sports injury requires an X-ray. An assessment can help determine whether the symptoms and examination findings suggest a fracture or another injury requiring imaging.

Do sprains show up on X-rays?

Standard X-rays primarily show bones and joints and aren’t generally used to directly visualise ligament sprains. However, an X-ray may be recommended following an apparent sprain when there is concern that a fracture may also be present.

Can you have a fracture even if you can walk?

Yes. Some people can still walk or bear weight despite a fracture, so the ability to walk doesn’t completely rule one out.

Do all fractures show on the first X-ray?

Not necessarily. Some fractures can be difficult to identify on initial imaging. If clinical suspicion remains despite an apparently normal X-ray, further assessment and sometimes additional or repeat imaging may be appropriate.