Summary
Usage The Ottawa Ankle Rule aids in the judicious use of radiography in acute and midfoot injuries. Indicated in patients ≥ 2 years with ankle or midfoot pain or tenderness in the setting of trauma but ought to use caution in ages < 18 years. Implementation of the Ottawa Ankle Rule may reduce unnecessary radiographs and radiation exposure while improving patient flow. Additionally, patients without criteria for imaging are unlikely to have a clinically significant fracture.. Summary Using the Ottawa Ankle Rule can reduce the number of unnecessary radiographs, limit radiation exposure, and improve patient flow. NotesOttawa Rules are good at ruling out fracture (high sensitivity) but poor for ruling in fractures (many false positives).High Sensitivity (90-100%) for ruling out clinically significant ankle and midfoot fractures (fracture/avulsion > 3 mm)Lower Specificity (41% for ankle & 79% for Foot) for ruling in facture, and not intended for specific diagnosis. ConsiderationsPalpate the entire distal 6 cm of the fibula and tibia.Weight bearing counts even if the patient limps.Precautions: Use clinical judgment if examination may be compromised for any of the following circumstances:IntoxicationDistracting painful injuriesGross swelling which prevents palpation of tendernessDiminished sensation in legsUncooperative patient RulesAn ankle x-ray series is only required if there is pain in the malleolar zone AND any of these findings:Bone tenderness at the posterior edge or tip of lateral malleolus, ORBone tenderness at the posterior edge or tip of medial malleolus, ORInability to bear weight both immediately after injury AND in ED.A foot x-ray series is only required if there is pain in the midfoot zone AND any of these findings:Bone tenderness at the base of 5th metatarsal, ORBone tenderness at the navicular, ORInability to bear weight both immediately after injury AND in ED..