Are three views necessary to examine acute ankle injuries?

In a retrospective review of the radiographs of 945 patients whose ankles were X-rayed for acute trauma over a 6 month period 95.3% of the 128 fractures identified were seen on anteroposterior and lateral films. The identification of six additional minor fractures by means of the 15 degrees internal oblique radiograph did not alter the management of individual patients and it is concluded that the routine use of oblique views is not justified. Radiological evidence of soft tissue swelling was present in 125 of the 128 fractures. The three patients in whom it was not seen had clinical evidence of local swelling and bruising. These findings indicate that fractures are highly unlikely to be present in the absence of local soft tissue swelling.