Ottawa ankle rules

Ankle

X-ray is only required if there is pain in the malleolar zone AND any of these findings:

1. Bony tenderness along the posterior edge or distal 6cm of either malleolus
2. Inability to bear weight for at least two steps with each foot immediately after the injury AND at the time of evaluation

Foot

X-ray is only required if there is pain in midfoot zone AND any of these findings:

1. Bony tenderness over the navicular bone
2. Bony tenderness over base of the 5th metatarsal
3. Inability to bear weight for at least two steps with each foot immediately after the injury And at the time of evaluation

Exceptions

1. ?age <18 or >55
2. only for blunt trauma mechanism
3. doesn't apply to subacute/chronic injuries
4. 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%^

Source

^Journal of Acc/Emerg Med 1999;16:342-344