The 'ABC' of examining foot radiographs.
BACKGROUND
We report a simple systematic method of assessing foot radiographs that improves diagnostic accuracy and can reduce the incidence of inappropriate management of serious forefoot and midfoot injuries, particularly the Lisfranc-type injury.


METHODS
Five recently appointed senior house officers (SHOs), with no casualty or Orthopaedic experience prior to their appointment, were shown a set of 10 foot radiographs and told the history and examination findings recorded in the casualty notes of each patient within 6 weeks of taking up their posts. They were informed that the radiographs might or might not demonstrate an abnormality. They were asked to make a diagnosis and decide on a management plan. The test was repeated after they were taught the 'ABC' method of evaluating foot radiographs.


RESULTS
Diagnostic accuracy improved after SHOs were taught a systematic method of assessing foot radiographs. The proportion of correct diagnoses increased from 0.64 to 0.78 and the probability of recognising Lisfranc injuries increased from 0 to 0.6.


CONCLUSIONS
The use of this simple method of assessing foot radiographs can reduce the incidence of inappropriate management of serious foot injuries by casualty SHOs, in particular the Lisfranc type injury.
Pearse
Eyiyemi O
EO
Department of Trauma and Orthopaedics, Princess Royal Hospital, Haywards Heath, West Sussex, UK. YemiPearse@aol.com
Klass
Benjamin
B
Bendall
Stephen P
SP
D002983:Clinical Competence; D003951:Diagnostic Errors / Q000517:prevention & control*; D004502:Education, Medical, Continuing / Q000379:methods*; D018409:Foot Injuries / Q000000981:diagnostic imaging*; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000000981:diagnostic imaging; D011859:Radiography