What initial imaging investigations are recommended for suspected fractures in adults and children?

Initial imaging investigations for suspected fractures in adults and children:

• For suspected long bone fractures in adults (16 or over), plain X-rays are the first-line imaging modality to confirm the fracture and assess displacement or involvement of joints ¹.
• In children (under 16), plain X-rays are also the initial imaging investigation for suspected fractures, including those involving growth plates, with a low threshold for same-day X-rays especially if there are safeguarding concerns or suspicion of slipped upper femoral epiphysis ¹,⁴,⁵,⁶.
• For suspected knee fractures in people over 2 years, use the Ottawa knee rules to determine the need for X-ray ¹.
• For suspected ankle fractures in people over 5 years, use the Ottawa ankle and foot rules to guide the need for X-ray ¹.
• For suspected scaphoid fractures, consider MRI as first-line imaging after thorough clinical examination, as it is more sensitive than X-ray ¹.
• For suspected spinal fractures, in adults (16 or over), CT is recommended if indicated by clinical rules (e.g., Canadian C-spine rule) or if neurological signs are present; MRI is used if neurological abnormalities suggest spinal cord injury ².
• In children with suspected spinal injury who do not meet MRI criteria but clinical suspicion remains, plain X-rays are recommended first, with further imaging as needed after radiologist review ².