Ottawa ankle rules
Ankle
X-ray is only required if there is pain in the malleolar zone AND any of these findings:
- Bony tenderness along the posterior edge or distal 6cm of either malleolus
- 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:
- 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
Exceptions
- ?age <18 or >55
- 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%^
See Also
Source
^Journal of Acc/Emerg Med 1999;16:342-344