Skeletal Survey or Bone Survey – Indications and Uses

By Dr Arun Pal Singh

A skeletal survey is a series of x-rays which are done to view the entire skeleton, performed systematically to cover the entire skeleton or the anatomic regions as per clinical indications.

Different clinical indications may demand a different set of x-rays. In the case of child abuse, which is a common indication, the local health protocols may differ slightly on the inclusion of different views of x-rays.

A bone survey takes X-rays of the:

skull
ribs
spine
pelvis
long bones [forearm, humerus, leg, femur]
any other bones that need to be looked at

A joint survey is often done along and includes views of wrist, elbow, shoulder, ankle, knee, hip and sacroiliac joints.

The aim of the skeletal survey is to identify focal or diffused abnormalities of the skeleton and in case of children to differentiate them from anatomic variations or developmental changes.

Indications of skeletal survey

Child abuse [suspected or known]
Widespread infections
Skeletal dysplasias
Bony Lesions
- Multiple myeloma
- Eosinophilic granuloma
- Metastasis
Paget’s disease
Metabolic bone disease like hyperparathyroidism
Rickets
Scurvy
Polyarticular arthropathy

It must be mentioned that barring child abuse, the survey is not required only when there are diagnostic difficulties.

Skeletal Survey in Child Abuse or Nonaccidental injury

Skull – AP and Lateral views
Chest
- AP & Lateral in inspiration
- Right and Left oblique for Ribs
  - Done in inspiration –
  - Include lower ribs.\
Abdomen
Pelvis
Bilateral femora
Both legs AP
Both feet AP
Coned view bilateral knees AP
Coned view bilateral ankles AP
Bilateral arms with hands – AP
Lateral view of spine

A follow-up survey is done after two 2 weeks.

The follow-up survey is usually the same as above except for skull, spine, and pelvis usually.

But if these were regions of concern previously, they should be included.

Skeletal survey for other Causes Such as Syndromes

Following is the list that generally encompasses most of the regions. But the x-rays to be done can be modified depending on the type of lesion and region of interest.

[While body CT is a more sensitive, faster and convenient investigation as compared to the skeletal survey. Availability, cost, and concerns for radiation dose are the drawbacks though]

Skull AP and Lateral views
Chest PA and Lateral views
Abdomen including pelvis
Left leg AP view
Left-arm AP view
Lateral view of the spine including the sacrum
Bilateral wrists and hands AP view
AP or dorsoplantar view of the foot

Skeletal Survey for Endocrine Lesions

Skull 3 views
- Anteroposterior
- Townes view
- Lateral view
Chest X-ray
- Posteroanterior view
- Lateral view
Abdomen including the pelvis and upper femora
Both legs AP view
Both feet dorsoplantar view
Both arms anteroposterior view
Lateral view of the spine

Skeletal Survey of Neonates

These are usually done in cases of syndromes and infection

X-rays in case of syndromes

AP and lateral views of the skull
Ap and lateral views of chest including thoracic spine
Lateral views of the lumbar, sacral & cervical spine
Abdomen including pelvis
Left leg, foot, arm and hand
- In case of asymmetries include both upper limbs

X-rays in case of Infections

Babygram
- Anteroposterior and lateral images of the child
- Should include chest, abdomen, shoulders & hips
Both arms AP views
Both legs AP
Views of the involved region if there is a local swelling or erythema.

Babygram or skeletal survey in congenital rubella syndrome
Image Credit: Open-i

Use of Skeletal Survey

X-rays are basic investigations and have widespread availability.

Skeletal survey, by the sheer number of x-rays included, requires preparations at all the fronts.

In the case of child abuse, the skeletal survey is mandatory in all cases of children younger than 2 years.

However, this screening is not found of much value in children older than 5 years.

The children between 2- to 5-year-olds must be considered individually.

For other ailments and lesions, whole body CT is a faster and convenient choice. But still, the skeletal survey is used as it is easily available.

Spread the Knowledge

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

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