A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. Ottawa ankle rules to exclude fractures of ankle and midfoot. They have nearly perfect sensitivity for identifying clinically significant ankle fractures. Ankle radiography is indicated only if a patient has pain in the malleolar zone and any of the following findings.
Patients with osseous pain in the lower 6 cm of the fibula or tibia or inability to bear weight immediately after. Pdf the sonographic ottawa foot and ankle rules study the. Pdf the sonographic ottawa foot and ankle rules study. The ottawa rules do not specify which radiograph, ankle or foot, to order. Aug 15, 2003 based on these data, they estimate that in most subgroups, less than 2 percent of patients with a negative ottawa rules assessment actually have a fracture of the ankle or mid foot. They state that an xray is required only in patients who have an acute knee injury with one or more of the following. The applicability of the ottawa ankle rules in children aged 216 years has been confirmed with 100% sensitivity for significant fractures of the ankle and mid foot. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision.
Usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. Ottawa ankle rules canadian chiropractic specialty college of. Use only for injuries ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. Eligibility criteria for selecting studies primary diagnostic studies reporting. Jun 15, 2012 bachmann lm, kolb e, koller mt, steurer j, ter riet g. The specificity of the ottawa ankle rules does not help rule in an ankle or foot fracture. Of those requiring radiographs in accordance with the ottawa foot and ankle rules. The mnemonic 445566pm helps to remember the components of the ottawa ankle and foot rule. Foot and ankle injuries are common in the emergency department ed. Sep 06, 2018 there are three sets of rules, one each for the foot, ankle and knee.
Electronic databases, reference lists of included studies, and experts. Racgp the ottawa knee rules a useful clinical decision tool. Pdf the original and modified ottawa ankle rules oars were developed as clinical decision rules cdrs for use in the emergency. Foot and ankle injuries are common presentations to the emergency department. Implementation of the ottawa ankle rules the fourth paper addressed the implementation of the ottawa ankle rules and the impact of their implementation on clinical practice. Applying the rules resulted in a relative reduction in ankle radiographs of 28% and in foot radiographs of 14%. Although the ottawa rules did not predict five ankle fractures, in four of these five cases the examiners clinical impression was of fracture.
The applicability of the ottawa ankle rules in children aged 216 years has been confirmed with 100% sensitivity for significant fractures of the ankle and midfoot. Data were extracted on the study population, the type of ottawa ankle rules used, and methods. Radiographic examinations showed 19 fractures out of 100 investigated patients table 1. Comparison of ottawa ankle rules and bernese ankle rules. This study compared assessment of suspected ankle and foot injuries using the ottawa ankle rules oar by nps and ed medical doctors eddrs. Ottawa rules explained to check for fractures duration. Racgp the ottawa knee rules a useful clinical decision. Clinical value of the ottawa ankle rules for diagnosis of. Feb 22, 2003 to summarise the evidence on accuracy of the ottawa ankle rules, a decision aid for excluding fractures of the ankle and mid foot. The ottawa foot rule for the use of xray in foot injury calculator assesses the use of xray in foot injury.
The ottawa knee rules okrs were first derived and validated in ottawa, canada, with the aim of reducing the number of unnecessary radiographs ordered after knee trauma without compromising patient care. Rules out clinically significant foot and ankle fractures to reduce use of xray imaging. Pdf validation of the ottawa ankle rules for acute foot and ankle. Patients who do not meet the fracture predictor of the okrs are highly unlikely to have clinically. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. Diagnostic accuracy of the ottawa ankle and midfoot rules. Ottawa ankle and foot rules an ankle xray is required only if there is any pain in malleolar zone and any of these findings. The ottawa ankle rules ankle fracture clinical prediction rule duration. Thus, if a patient does not pass the full set of clinical criteria, the treating provider must do further clinical evaluation in order to assess for a fracture and whether an xray is required for management. The sonographic ottawa foot and ankle rules study the sofar study marieta d canagasabey,1 michael j callaghan,2 simon carley3 abstract introduction foot and ankle injuries are common in the emergency department ed. However the vast majority of patients with unclear ankle injuries do not have bone fractures. To summarise the evidence on accuracy of the ottawa ankle rules, a decision aid for excluding fractures of the ankle and mid foot.
Update on acute ankle sprains american family physician. Data sources medline, embase, cinahl, sportdiscus and cochrane library. 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. Ottawa ankle rules to exclude fractures of ankle and mid foot. Ottawa rules regarding requirement for ankle xray general. Ottawa knee and ankle rules pdf ottawa ankle and foot rules. Use of these rules reduced radiographic examinations by 28% for the ankle and 14% for the foot. Ottawa ankle rules for the injured ankle british journal. Criteria ottawa knee rules xray for acute injury of the knee. Jun 27, 20 nurse practitioners nps in the emergency department ed have been trained to assess a range of clinical problems and minor complaints such as acute ankle injury. Ottawa ankle rules for the injured ankle british journal of. A foot xray is required if there is any pain in the midfoot zone and any of these findings. A clinical decision rule to determine the need for diagnostic imaging for ankle andor foot trauma. Effect of triagebased use of the ottawa foot and ankle rules.
Before the introduction of the rules most patients with ankle injuries would have been imaged. 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. Comparison of ottawa ankle rules and bernese ankle rules in. While all of these rules can be used in patients under the age of 18, they should be used with caution. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce. Effect of triagebased use of the ottawa foot and ankle. Ottawa knee rule ottawa hospital research institute. Ankle injuries account for nearly 2 million visits to the emergency department ed in the united states and canada each year. Tenderness of patella is significant only if an isolated finding. Accuracy of ottawa ankle rules to exclude fractures of the ankle and mid foot. Prospectively validated in 1993 by stiell et al, 3 the ottawa ankle rule requires localized bone tenderness of the posterior edge or tip of either malleolus or the inability to bear weight both immediately after the injury or in the ed.
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. The ottawa knee rules are a set of rules used to help physicians determine whether an xray of the knee is needed. Ottawa ankle rules the ottawa hospital research institute. The ottawa foot rule was also validated during the same study and requires bone tenderness at the base of the fifth metatarsal, bone tenderness. Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days.
Aug 19, 2016 the ottawa ankle rules are used as a clinical prediction rule to rule out an ankle fracture in an acute situation without the need for an xray. Ottawa foot rule for the use of xray in foot injury. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency. The ottawa ankle rules oar are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries. Sensitivities for the ottawa ankle rule range from the high 90% to 100% range for clinically significant ankle and midfoot fractures. Nurse practitioners treating ankle and foot injuries using. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. Ottawa foot rule for the use of radiographs in foot injury. The oar have been proven that their application reduces unnecessary radiography. Rules have been prospectively validated on multiple occasions.
Use only for injuries ottawa ankle rules were established to help physicians decide which patients should have an xray following an acute ankle injury. There are three sets of rules, one each for the foot, ankle and knee. The ottawa foot rule was also validated during the same study and requires bone ten derness at the base of the fifth metatarsal, bone tenderness at the navicular, and the inability to bear weight both immediately after the injury and in the ed. Ottawa ankle rules an overview sciencedirect topics. Bachmann lm, kolb e, koller mt, steurer j, ter riet g. The ottawa knee rules were developed in an attempt to allow physicians to be more selective with radiography, without missing fractures. Of those requiring radiographs in accordance with the ottawa foot and ankle rules, approximately 22% have a fracture. Use only for injuries ottawa ankle and midfoot rules and explore if clinical features andor methodological quality of the study influence diagnostic accuracy estimates. Ottawa rules simplify the management of ankle injuries.
This would allow a reduction in radiographs of the ankle of 16% and of the foot by 29%, without missing any clinically significant fracture. Ben yates, in clinical skills in treating the foot second edition, 2005. The ottawa ankle rules were established to help physicians decide which patients should have an xray following an acute ankle injury. The ottawa ankle rules calculator rules out unnecessary xray imaging in the case of ordinary ankle and foot injuries in patients aged from 3 to 55 years old. The ottawa ankle rules are guidelines indicating that xray studies should be obtained if there is pain in the malleolar zone and a bony tenderness at the distal 6 cm of the fibula or b bony tenderness at the distal 6 cm of the tibia or inability to take 4 steps immediately after injury.
The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging. The ottawa ankle rule was derived to aid efficient use of radiography in acute ankle and midfoot injuries. Ottawa foot rule for the use of radiographs in foot injury calculator. The oar are a reliable tool to exclude fractures in children over 5 years of age when applied by physicians. The ottawa ankle rules were developed to identify those subjects with an ankle sprain who required radiographs to rule out the presence of subtle or frank fracture. An ankle xray is required only if there is any pain in malleolar zone and any of these findings.
The ottawa rules have been described and evaluated by steil et al 1,2. Knee rule for knee injury radiography a knee xray series is only required for knee injury patients with any of these findings. The ottawa ankle rules ankle fracture clinical prediction. Unable to transfer weight twice onto each lower limb regardless of limping.
Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. Background the ottawa ankle rules oar are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The ankle component of the oar states that radiographic evaluation of the ankle is only necessary if there is pain in the malleollar zone and one of the. Evidence supports the ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid foot. The parameters used in the calculator include pain in the foot, inability to bear weight right after the injury as well as in the emergency department, and bone tenderness at the navicular or the base of the fifth metatarsal.
It is based on the ottawa ankle rules which concern pain and tenderness in key areas of the limbs. This guideline makes recommendations for adults aged. Sensitivity and specificity of oar were 100% and 77% respectively. O ottawa rules for xray of knee, ottawa ankle and foot rules lateral view ankle and foot medial view posterior edge or tip of medial malleolus navicular malleolar zone midfoot zone posterior edge or tip of lateral malleolus base of 5th metatarsal 6cm an ankle xray is required only if there is any pain in malleolar zone and any of these findings. The ottawa knee rules are useful in ruling out fracture high sensitivity when negative, but poor for ruling in fractures many false positives. Ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf download. 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. Accuracy of ottawa ankle rules to exclude fractures of the.
Unable to bear weight both immediately and in the emergency room department for 4 steps. The ottawa ankle rules oar are a set of clinical decision rules that were derived and validated by stiell et al. Specificities for the ottawa ankle rule are approximately 41% for the ankle and 79% for the foot, although the rule is not designed or. Hence there may be cases in which the criteria for an ankle injury actually predict a foot fracture. More recent evidence also supports the ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid foot. The sonographic ottawa foot and ankle rules study the. Objectives the purpose of this study was to assess the. Use only for injuries ottawa foot rule for the use of xray in foot injury calculator assesses the use of xray in foot injury. Imaging is required if there is pain in the mid foot zone and any of the following. The ottawa ankle and foot rules to image or not to.
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