Ottawa ankle rules: Difference between revisions

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==Ankle==
==Background==
X-ray is only required if there is pain in the malleolar zone AND any of these findings:
*Nearly 100% sensitive<ref>Bachmann LM, Kolb E, Koller MT, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003; 326(7386):417.</ref>
#Bony tenderness along the posterior edge or distal 6cm of either malleolus
*98.5% sensitive in the pediatric population<ref>Dowling S, Spooner CH, Liang Y, et al. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009; 16(4):277-87.</ref>
#Inability to bear weight for at least two steps with each foot immediately after the injury AND at the time of evaluation
*Can reduce ED utilization of x-rays<ref>Stiell, IG, et al. Implementation of the Ottawa Ankle Rules. JAMA. 1994; 271:827-832.</ref>
 
==Foot==
X-ray is only required if there is pain in midfoot zone AND any of these findings:
#Bony tenderness over the navicular bone
#Bony tenderness over base of the 5th metatarsal
#Inability to bear weight for at least two steps with each foot immediately after the injury And at the time of evaluation


==Criteria==
{{Ottawa Ankle Rules}}


{{Ottawa Foot Rules}}


===Exceptions===
===Exceptions===
#?age <18 or >55
#Age <6 or >55
#doesn't apply to pediatrics
#Only for blunt trauma mechanism
#only for blunt trauma mechanism
#Does not apply to subacute/chronic injuries
#doesn't apply to subacute/chronic injuries
#Does not apply to injuries of the hindfoot or forefoot
#doesn't apply to injuries of the hindfoot or forefoot
 
0.5% of pt's not xrayed were found to have minor fractures on follow up xray in 5-7 days.


Although it doesn't apply to peds, a study of 1500 patients age 1-15 showed a sensitivity of 98%^
==External Links==
[http://www.mdcalc.com/ottawa-ankle-rules/ MDCalc - Ottawa Ankle Rules]


==See Also==
==See Also==
*[[Ankle (Main)]]
*[[Ankle Fracture]]
*[[Foot Diagnoses]]
*[[EBQ:Ottawa Ankle Rule Study|Ottawa Ankle Rule Study]]
*[[Ottawa Knee Rules]]


==Source==
==References==
^Journal of Acc/Emerg Med 1999;16:342-344
<references/>


[[Category:Ortho]]
[[Category:Orthopedics]]

Latest revision as of 22:13, 27 March 2024

Background

  • Nearly 100% sensitive[1]
  • 98.5% sensitive in the pediatric population[2]
  • Can reduce ED utilization of x-rays[3]

Criteria

Ottawa ankle rule

Ottawa ankle rule

Ankle x-ray needed if:

  • Pain near the maleoli AND
  • Inability to bear weight immediately and in the ED (4 steps) OR
  • Tenderness at posterior edge or tip of lateral malleolus OR
  • Tenderness at posterior edge or tip of medial malleolus

Ottawa foot rules

Ottawa foot rules

Foot x-ray series needed if:

  • Pain in the midfoot AND
  • Inability to bear weight both immediately and in the ED (4 steps) OR
  • Tenderness at the navicular OR
  • Tenderness at the base of the 5th metatarsal

Exceptions

  1. Age <6 or >55
  2. Only for blunt trauma mechanism
  3. Does not apply to subacute/chronic injuries
  4. Does not apply to injuries of the hindfoot or forefoot

External Links

MDCalc - Ottawa Ankle Rules

See Also

References

  1. ↑ Bachmann LM, Kolb E, Koller MT, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003; 326(7386):417.
  2. ↑ Dowling S, Spooner CH, Liang Y, et al. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009; 16(4):277-87.
  3. ↑ Stiell, IG, et al. Implementation of the Ottawa Ankle Rules. JAMA. 1994; 271:827-832.
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