Since its derivation and validation in 1992, the Ottawa ankle rules are the most frequently used clinical decision tool when considering to obtain ankle x-rays. While sprains are the most common injuries (most common = anterior talofibular ligament), the patient still needs to be assessed for fracture. Traumatic ankle pain is a common presenting problem to emergency departments. There is swelling and ecchymosis diffusely with tenderness at the tip of the lateral malleolus. 275(8):641-642.Author: Jeremy Kim, MD (EM Resident Physician, Icahn School of Medicine at Mount Sinai) // Edited by: Alex Koyfman, MD EM Attending Physician, UTSW / Parkland Memorial Hospital) & Justin Bright, MD Clinical ScenarioĪ 25-year-old male presents with a left ankle injury while playing basketball. Acute knee injuries: use of decision rules for selective radiograph ordering. The Canadian C-spine rule for radiography in alert and stable trauma patients.
#Broken ankle xray trial
Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Interobserver agreement between physical therapists and orthopaedic surgeons. A prospective study of modified Ottawa ankle rules in a military population. Springer BA, Arciero RA, Tenuta JJ, Taylor DC.Diagnosis and management of scaphoid fractures. Combining the clinical signs improves diagnosis of scaphoid fractures. Parvizi J, Wayman J, Kelly P, Moran CG.Comparison of the Canadian C-Spine rule and NEXUS decision instrument in evaluating blunt trauma patients for cervical spine injury. Ottawa and Pittsburgh rules for acute knee injuries. Can elbow extension be used as a test of clinically significant injury? South Med J. A protocol for selecting patients with injured extremities who need x-rays. Brand DA, Frazier WH, Kohlhepp WC, et al.
The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Bachmann LM, Haberzeth S, Steurer J, ter Riet G.Below, watch Robert Boyles discuss the different ankle imaging views in a short video from his course, Imaging for Lower Quarter Sports Injuries. Whether it’s the Ottawa Ankle Rules or another clinical decision directive, if you use and understand these rules, you can easily improve your patient outcomes.
This is just one example of how clinical criteria can help you with your decision to order imaging.
If neither of these criteria is present, no imaging is needed.īy knowing these rules and using them correctly, you can: There is any pain in the midfoot zone and any of the following: Inability to take 4 steps both immediately and in the emergency departmentī.There is any pain in the malleolar zone and any of the following:
#Broken ankle xray series
Using the diagram below we can determine when an ankle series is required. The rule’s reported sensitivity is 1.0, so X-rays are necessary if any of the below are met:Ī. 10,11,13,14 The instructions and associated figure below layout these guidelines. Knowing when to order X-rays, or even what to order, can be confusing. The Ottawa Ankle Rules, developed by Stiell, specifies the criteria to be met before ordering X-rays for a patient presenting with an acute ankle injury.
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