Key Feature 3: In patients with suspected fractures that are prone to have normal X-ray findings (ex: scaphoid fractures in wrist injuries, elbow fracture, growth plate fracture in children, stress fractures), manage according to your clinical suspicion, even if X-ray
Skill: Clinical Reasoning, Selectivity
Key Feature 4: In assessing elderly patients with an acute change in mobility (i.e., those who can no longer walk) and equivocal X-ray findings (ex: no obvious fracture), investigate appropriately (ex: with bone scans, computed tomography) before excluding a fracture.
Skill: Clinical Reasoning
So that key feature is definitely not a complete sentence, and just like a suspected fracture with a negative x-ray, it leaves you hanging. X-rays are never 100% sensitive for fractures, sometimes not even approaching this depending on the fracture type, and there are fractures that have a higher risk of negative consequences if the bone/affected joint is not immobilised. Let's go through some of the more common circumstances in which having a higher index of suspicion of fracture is warranted.