Ottawa ankle rules: Difference between revisions

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==Rule==
==Background==
Order ankle xrays when:
*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>
## pain in the medial malleolar zone
*Can reduce ED utilization of x-rays<ref>Stiell, IG, et al. Implementation of the Ottawa Ankle Rules. JAMA. 1994; 271:827-832.</ref>
## pain in lateral malleolar zone
# Inability to bear weight for at least two steps with each foot immediately after the injury and at the time of evaluation


Order foot xrays when there is any pain in the mid-foot zone and any of these findings:
==Criteria==
# Bony tenderness over the navicular bone
{{Ottawa Ankle Rules}}
# 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


===exceptions===
{{Ottawa Foot Rules}}
#?age <18 or >55
#doesn't apply to pediatrics
#only for blunt trauma mechanism
#doesn't apply to subacute/chronic injuries
#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.
===Exceptions===
#Age <6 or >55
#Only for blunt trauma mechanism
#Does not apply to subacute/chronic injuries
#Does not apply to injuries of the hindfoot or forefoot


Although it doesn't apply to peds, a study of 1500 patients age 1-15 showed a sensitivity of 98% (Journal of Acc/Emerg Med 1999;16:342-344)
==External Links==
[http://www.mdcalc.com/ottawa-ankle-rules/ MDCalc - Ottawa Ankle Rules]


[[Category:Ortho]]
==See Also==
*[[Ankle (Main)]]
*[[Ankle Fracture]]
*[[Foot Diagnoses]]
*[[EBQ:Ottawa Ankle Rule Study|Ottawa Ankle Rule Study]]
*[[Ottawa Knee Rules]]
 
==References==
<references/>
 
[[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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