Which finding would most strongly prompt immediate radiography in an extremity injury?

• A. Localized bone tenderness
• B. Mild swelling with no deformity
• C. Ability to bear weight normally
• D. Chronic joint pain

Answer: (B)

In extremity injuries, the decision to radiograph hinges on signs that a fracture or hidden injury could be present, even if the outside looks relatively calm. Swelling after an injury can mask underlying bone injury and may indicate an occult fracture that isn’t obvious from deformity or simple tenderness. When there is mild swelling with no obvious deformity, the concern for a fracture remains, and imaging is prudent to rule out something that could worsen if missed.

By contrast, having localized bone tenderness is already a strong indicator that a fracture could be present and would also lead you to image, but in this scenario the mild swelling without deformity stands out as the scenario where you’d most strongly justify immediate radiography to detect fractures that aren’t overt on exam. An ability to bear weight normally lowers suspicion for fracture, and chronic joint pain isn’t an acute injury finding requiring emergent imaging.