Lower Leg (Shin) X-ray (both sides)

What it is

The lower leg is built from a thick weight-bearing bone at the front, the tibia, and a slender one running alongside it, the fibula. A break along the length of the tibia takes real force — a fall from a height, a road collision, a sports impact — and the fibula frequently breaks in the same event. The film covers the whole span from below the knee to above the ankle in two directions, because the report has to place the break along that span and say whether it runs into either joint at the ends. Whether the fibula is broken as well, and where, changes how stable the leg is. Since the tibia lies just beneath the skin with little muscle over it, the films are also read alongside a careful look at the skin: a break here can come through the surface.

Why it is done

• To identify a fracture of the shinbone and to locate it along the length of the bone
• To show whether the fibula is broken too, and whether either break extends into the knee or ankle joint
• To check that a leg treated in a cast or brace has held its position as swelling settles
• To confirm the placement of a rod, plate, or external frame after surgical fixation, and to follow the bone as it knits over the following months
• To assess persistent shin pain when a bone problem rather than a soft-tissue one is suspected, keeping in mind that a very early stress fracture may not appear on a plain film at all

What to expect

The leg is laid on the plate and the beam is set to cover knee to ankle in one image, then the leg is turned for the side view. A splint or cast stays on and is imaged through. It takes a few minutes per leg. Acute injuries are positioned gently and sometimes imaged where the patient lies rather than moved. Healing is followed with repeat films over months rather than weeks, because these are large bones that take their time. A radiologist reports each study.

Questions worth asking

• If the first films were taken in a trauma bay with portable equipment, is that billed differently from the same study done in the radiology department?
• Healing here is followed over months. How many follow-up studies are expected in total, and is each one billed as a full new x-ray with a new reading fee?
• If a knee or ankle x-ray is added because the break runs toward a joint, is that a separate code on the same visit?
• When films are taken in the operating room during fixation, are they part of the surgical bill or a separate imaging charge?