Purpose Annually approximately 18,044 patients are admitted to Dutch hospitals with hip fractures. This is an increasing demand for medical care due to the increasing amount of elderly people. Although previous studies showed that routine check of X-rays following hip fracture surgery is unnecessary, it remains routine in most clinics in the Netherlands. In addition to the radiation exposure to the patient, it is painful and leads to unnecessary costs. This study aims to establish if routine check X-rays 1 day after internal fixation for hip fracture with adequate image intensifier guidance influence postoperative management. Patients and methods A retrospective study was performed for all patients undergoing internal fixation of hip fractures with image intensifier guidance in the period from January 2006 until December 2007 in our hospital. Results In that period 294 patients underwent internal fixation of hip fractures, 254 underwent a check X-ray and were included in this study. In only two patients the check X-ray did change patient management. Conclusion A check X-ray following internal fixation of hip fractures after adequate peroperative image intensifier guidance is not useful. Dismissing this unuseful medical investigation, leads to less radiation exposure, less pain and less costs.