Ottawa Ankle Rules
The Ottawa Ankle Rules, developed by Stiell et al from Ottawa, Canada, are a set of guidelines designed to assist in the decision if a patient with foot or ankle pain should be offered x-rays to diagnose a possible fracture.1
A CIAP fulltext link to the Ottawa Ankle Rules guideline is available here.2
In summary of the guideline, according to the Ottawa Ankle Rules, x-rays are only required if there is any pain in the malleolar or midfoot area, and any one of the following:
- Bone tenderness along the distal 6cm of the posterior edge of the tibia or tip of the medial malleolus
- Bone tenderness along the distal 6cm of the posterior edge of the fibula or tip of the lateral malleolus
- Bone tenderness at the base of the fifth metatarsal (for foot injuries).
- Bone tenderness at the navicular bone (for foot injuries).
- An inability to bear weight both immediately and in the emergency department for four steps.3
Certain groups are excluded, in particular children (under the age of 18), the pregnant, and those with diminished ability to follow the test (for example due to head injury or intoxication).3
A multi centre trial of the implementation of the Ottawa Ankle Rules which enrolled 12,777 patients showed a reduction of patients requiring a x-ray from 83% to 61% with a subsequent reduction in the time to discharge for the emergency department for those patients without fracture.4
References:
1. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992 Apr;21(4):384-90.
2. Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa ankle rules. JAMA. 1994 Mar 16;271(11):827-32. (CIAP full text link)
3. Wikipedia, Ottawa Ankle Rules, accessed 14th February 2007. <http://en.wikipedia.org/wiki/Ottawa_ankle_rules>
4. Stiell I, Wells G, Laupacis A, Brison R, Verbeek R, Vandemheen K, Naylor CD. Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group. BMJ. 1995 Sep 2;311(7005):594-7. (CIAP full text link)
Also in this section:
» NSW ITIM Trauma Guidelines» Ottawa Knee Rules