Rules of Twos in Orthopaedics

Rules of Twos?

• Two views—one view is always one view too few
• Two abnormalities—if you see one abnormality, check for a second one
• Two joints—image the joint above/below
• Two sides—if not sure or difficult X ray, compare with opposite side
• Two views, too many- CT scan has advantage in many situations.
• Two occasions—always compare with old Xrays IF available
• Two visits—Don’t hesitate to ask patient to visit again for a repeat exam
• Two opinions and two records—always ask a colleague if in doubt and make a record
• Two Specialists: Don’t hesitate to get an opinion from another dept(Radiology/Surgery)
• Two investigations—always consider whether US, CT or MRI would help in diagnosis

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