The ottawa ankle rules and the buffalo modification of the ottawa rules should be judiciously applied to adult patients with ankle trauma to decrease the total number of ankle radiographs obtained the most important step in ankle fracture management is identifying stable verses unstable fractures. If you do not have it you can download adobe reader free. If you do not have it you can download adobe reader free of charge. To open a pdf file you will need compatible software such as adobe reader. To decide if radiography is needed, in 1992 stiell et al. Less than a decade ago, clinical epidemiologist ian stiell, working with emergency department physicians, formulated the ottawa ankle rules. A prospective study of modified ottawa ankle rules in a military. Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. Diagnostic performance of the bernese versus ottawa ankle. The oar is a clinical decision rule that allows clinicians to examine an injured ankle or mid. When almost every patient entering the emergency department with an ankle sprain undergoes radiography, even modest values for specificity. The rules appear on the front page of this document. The rules are intended to guide clinical decisions about the efficient use of radiography in the diagnosis of malleolar zone fractures and midfoot zone fractures, minimising expenditure. Oct 10, 2016 the ottawa ankle rules, developed by stiell, specifies the criteria to be met before ordering xrays for a patient presenting with an acute ankle injury.
Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. Assessment of an ankle injury begins with a detailed history to determine the severity. Ottawa ankle rules an overview sciencedirect topics. An ankle xray series is only required if there is any pain in the malleolar zone and. Radiographic examinations showed 19 fractures out of 100 investigated patients table 1. Stable fractures will have only one break in the supporting ankle ring, whereas unstable. Is to remember that an xray of the foot is required if the patient has pain at the basis of the 5th metatarsal of at the 5caphoid 66pm. Decision rules for the use of radiography in acute ankle.
Sensitivity and specificity of oar were 100% and 77% respectively. Ankle radiography is indicated only if a patient has pain in the malleolar zone and any of the following findings. The ottawa ankle rules are physical exam findings that help predict the likelihood of an osseous ankle injury. Ankle radiographs are suggested if there is pain in the malleolar region with any of the following. Background the ottawa ankle rules oar are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The keywords ankle injury, clinical decision rule, paramedic, ambulance, prehospital, and emergency care were used to frame the search, while a prehospital and emergency care search filter was used to maximise the sensitivity of the search. Stiell ig, greenberg gh, mcknight rd, nair rc, mcdowell i, reardon m, stewart jp, maloney j. The ottawa knee rules recommend knee xrays for any.
Comparison of ottawa ankle rules and bernese ankle rules. Diagnosis historically imaging is ordered for most patients presenting with an ankle andor midfoot injury even though only about 15%. Ankle radiography is required if there is pain in the malleolar zone, and if one of the following is present. Prospective validation of a decision rule for the use of radiography in acute knee injuries. Effect of the low risk ankle rule on the frequency of. Is to remember that an xray is required if the patients is unable to walk 4 steps at the moment of the accident and during the physical examination 55. A study to develop clinical decision rules for the use of radiography in acute ankle injuries.
What is the clinical evidence for the accuracy of the ottawa ankle rules to determine the need for x rays to identify potential bone fracture. This would allow a reduction in radiographs of the ankle of 16% and of the foot by 29%, without missing any clinically significant fracture. Use of the ottawa ankle rules by nurse practitioners. Use of the ottawa ankle rule by paramedics in the outof. Validity of the ottawa rules for xray request in ankle. Most of these patients will have sustained simple injury to ligamentous soft tissue or a small avulsion fracture of no. They have nearly perfect sensitivity for identifying clinically significant ankle fractures. Decision rules for the use of radiography in acute ankle injuries. Oct 15, 20 the low risk ankle rule states that if a child with an ankle injury has a lowrisk examination i. Apr 03, 2008 the mnemonic 445566pm helps to remember the components of the ottawa ankle and foot rule.
Multi trial to introduce the ottawa ankle rule for the use of radiography in acute ankle injuries the fifth study assessed the feasibility and impact of introducing the ottawa ankle rules in a. Update on acute ankle sprains american family physician. The ottawa ankle rule was derived to aid efficient use of radiography in acute ankle and midfoot injuries. Where indicated the nurse sent the patient for radiography. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns are almost always simple, lack of fracture diagnosis can lead to. Ottawa ankle rules xray for acute injury of the ankle or mid. They are also careful to point out several groups in whom they do not feel the rules should be applied, such as the intoxicated, the multiply injured, or. Racgp the ottawa knee rules a useful clinical decision tool. In medicine, the ottawa ankle rules are a set of guidelines for clinicians to help decide if a patient with foot or ankle pain. Implementation of the ottawa ankle rules in france. However the vast majority of patients with unclear ankle injuries do not have bone fractures. Synonyms for modified ottawa ankle rules in free thesaurus. Comparison of ottawa ankle rules and bernese ankle rules in.
Multi trial to introduce the ottawa ankle rule for the use of radiography in acute ankle injuries the fifth study assessed the feasibility and impact of introducing the ottawa ankle rules in a wide variety. Ottawa ankle rules and subjective surgeon perception to evaluate. Ottawa ankle rules for the injured ankle useful clinical rules save on radiographs and need to be used widely w hat could possibly be more straightforward than the assessment of an injured ankle. Bone tenderness at the posterior edge or tip of the lateral malleolus a.
Inability to walk 4 steps immediately after an injury localized tenderness of the posterior edge or tip of either malleoli localized tenderness of the navicular bone or base of 5th metarsal if. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. In about 15% of patients visiting the ed with ankle or midfoot trauma, a fracture is diagnosed. The ottawa ankle rules and missed fractures of the talus. Ottawa ankle rules definition of ottawa ankle rules by the. Before the introduction of the rules most patients with ankle injuries would have been imaged. Ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf download. Papers p 417 what could possibly be more straightforward than the assessment of an injured ankle.
There are two components, assessing for ankle and midfoot fractures. These files will have pdf in brackets along with the filesize of the download. Ankle rules for ankle injury radiography a an ankle xray series is only required if there is any pain in malleolar zone and any of these findings. Usethe ottawa ankle rules oar to exclude fractures and reduce unnecessary imaging. Sports ankle injuries assessment and management pdf. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot in children. Ottawa ankle rules for excluding ankle and midfoot fractures does the patient have. Ottawa knee rule ottawa hospital research institute. Palpate the entire distal 6 cm of the fibula and tibia. Diagnostic accuracy of the ottawa ankle and midfoot rules.
Ottawa ankle rules xray for acute injury of the ankle or. Rules out clinically significant foot and ankle fractures to reduce use of xray imaging. Clinical practice use of the ottawa ankle rule by paramedics. Ottawa ankle rules definition of ottawa ankle rules by. The ottawa ankle rule is useful for ruling out fracture high sensitivity, but poor for ruling in fractures many false positives. Validity of the ottawa rules for xray request in ankle and.
Modified ottawa ankle rules synonyms, modified ottawa ankle. To assess the impact of the implementation of the ottawa ankle rules on radiography requests in french hospitals during a 5month intervention period and the impact of using posters alone to sustain the effect of the rules during a 5month postintervention period. Since 1992, the ottawa ankle rules oar can assist clinicians in determining whether an xray should be performed to exclude a fracture. Ottawa ankle rules synonyms, ottawa ankle rules pronunciation, ottawa ankle rules translation, english dictionary definition of ottawa ankle rules. Ottaaw knee rule for knee injury radiography stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla. Eligibility criteria for selecting studies primary diagnostic studies reporting. The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging.
Rules have been prospectively validated on multiple occasions. Criteria ottawa knee rules xray for acute injury of the knee. Clinical value of the ottawa ankle rules for diagnosis of. Data sources medline, embase, cinahl, sportdiscus and cochrane library. Ottawa ankle rules for the injured ankle british journal. Ankle injuries are extremely common but many features on history and physical examination are unreliable the combined ottawa ankle and foot rules have a sensitivity of 97.
Ottawa ankle rules ottawa hospital research institute. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. Ankle sprain is frequently encountered, both in primary care and in emergency departments. Accuracy of ottawa ankle rules to exclude fractures of the ankle and. The ankle is a complex joint which is capable of a wide range of movement.
Comparison of ottawa ankle rules and bernese ankle rules in acute ankle and midfoot injuries injury during daily walking, and the remaining reported other reasons. Acute trauma to the ankle american college of radiology. Patients with ankle injuries, usually sus tained recreationally or in a simple fall, attend emergency departments throughout the world in their. To determine the ability of nurse practitioners to use the ottawa ankle rules by comparing their requests for radiography with those of senior house officers shos. The oar have been proven that their application reduces unnecessary radiography. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. Usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. Clinical evidence, costeffectiveness, and guidelines. Patients with ankle injuries, usually sustained recreationally or in a simple fall, attend emergency departments throughout the world in their hundreds of thousands every year. Racgp the ottawa knee rules a useful clinical decision. Most are inversion and plantar flexion injuries that lead to damage to the lateral ligaments. Editor,further to previous correspondence i think the use of the ottawa ankle rule needs some clarification. Patient does not meet requirements for evaluation by the ottawa ankle rules. The ottawa ankle rules were established to help physicians decide which patients should have an xray following an acute ankle injury.
Do not neglect the importance of medial malleolar tenderness. Using the diagram below we can determine when an ankle series is required. To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. Ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf download.
Hanley and belfus dowling s, spooner ch, liang y et al. In medicine, the ottawa ankle rules are a set of guidelines for clinicians to help decide if a patient with foot or ankle pain should be offered xrays to diagnose a possible bone fracture. Group 1 65 patients was assessed by nurse practitioners trained in the use of the ottawa ankle rules and sent for a. Julian brooks a total of 2763 patients over 16 years of age presenting within 24 hours of an acute, closed, isolated ankle injury were entered into the study which was divided into three groups. May 09, 20 inversion type foot ankle injury on uneven pavement. An ankle xray is required only if there is any pain in malleolar zone and any of these findings. To determine the necessity of ankle and foot radiographs, we used modified. Pdf download for a prospective study of modified ottawa ankle rules in a. Pdf most of the documents on the racgp website are in portable document format pdf. Patients with acute ankle and midfoot trauma constitute approximately 5% of all emergency department ed presentations.
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