Ottawa ankle rules
- Nearly 100% sensitive
- 98.5% sensitive in the pediatric population
- Can reduce ED utilization of x-rays
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
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
- 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
- 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.
- 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.
- Stiell, IG, et al. Implementation of the Ottawa Ankle Rules. JAMA. 1994; 271:827-832.