Knee radiographs: a substitute for proper clinical examination within the accident and emergency department?

Over a 2-month period in an accident and emergency department, the clinical benefits and cost-effectiveness of radiology of the knee after trauma was audited. In all, 178 patients had radiographs as part of their initial assessment, the majority of which were subsequently reported by the radiologist as entirely normal (90.4 per cent of films after a twisting injury and 80.6 per cent after a direct blow). Early and appropriate clinical review by a senior doctor is proposed as a viable alternative to perhaps unneeded radiographs where the physical signs of injury are minimal. The clinical and financial benefits of such a policy are discussed.