Ottawa ankle rules

Rule

Order ankle xrays when there is any pain in the medial or lateral 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

Order foot xrays when there is any pain in the mid-foot zone and any of these findings:

1. Bony tenderness over the navicular or at the base of the 5th metatarsal

2. Inability to bear weight for at least two steps with each foot immediately after the injury and at the time of evaluation

exceptions:

age 18-55

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.

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)