Pediatric ankle injuries result in more than 2 million emergency department visits in canada and the united states each year jeanette tyas, canadian institute of health information. Basketball season is back and with it comes a new season of early morning conditioning runs, late night pickup games, and of course, a few ankle sprains along the way. A foot xray series is only required if there is any pain the midfoot zone and. The ottawa ankle rules were established to help physicians decide which patients should have an xray following an acute ankle injury. Foot and ankle injuries are frequent in emergency departments. Ottawa ankle rules to exclude fractures of ankle and midfoot. Specificity represents the number of patients without the condition and. Mar 04, 2014 ottowa ankle and foot rules ankle radiographs are only required if there is pain in the malleolar area and any one of the following. Ottawa ankle rules and subjective surgeon perception to evaluate. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot in children.
Update on acute ankle sprains american family physician. To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. 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. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. Eligibility criteria for selecting studies primary diagnostic studies reporting. Ottawa ankle rules definition of ottawa ankle rules by. Xray requesting patterns before and after introduction of the ottawa knee rules in a uk emergency department. Stress radiography is an unreliable tool to detect acute ligamentous disruption after ankle sprain. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot. Patients waited less, were not dissatisfied with their treatment, and significant fractures did not go undetected. Ottowa ankle and foot rules ankle radiographs are only required if there is pain in the malleolar area and any one of the following.
Racgp the ottawa knee rules a useful clinical decision tool. All 2342 adults seen with acute ankle injuries during 5month periods before and after the intervention. This guideline makes recommendations for adults aged. The north shore foot ankle group makes no claims, expressed or implied as to the accuracy and timeliness of any advice, services, or other information referenced in the website. The oar have been proven that their application reduces unnecessary radiography. Proportions of patients referred for standard ankle and foot radiographic series. The ottawa ankle and foot rules to image or not to. Ottawa ankle rules canadian chiropractic specialty college of. Diagnostic accuracy of the ottawa ankle and midfoot rules. Mar 06, 20 how to use the ottawa ankle and foot rule. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. Rules have been prospectively validated on multiple occasions. 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.
The need for need for radiography is reduced by 36% saving patients money and time. Bone tenderness over the distal 6cm of the posterior edge or tip of the lateral malleolus bone tenderness over the distal 6cm of the posterior edge or tip of the medial malleolus. Rules out clinically significant foot and ankle fractures to reduce use of xray imaging. Full text get a printable copy pdf file of the complete article 915k, or. Implementation of the ottawa ankle rules by resident orthopaedic. Table 1 shows the calculations for a cohort of 1,000 persons, in whom there were 100 actual fractures, applied to the best, average. Comparison of ottawa ankle rules and bernese ankle rules in. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of an ankle and or foot injury using the ottawa ankle. Sensitivity and specificity of oar were 100% and 77% respectively. Analogous rules have been formulated for knee and head injuries. Full text get a printable copy pdf file of the complete article 915k, or click on a page image below to browse page by page.
Ottawa ankle rules an accurate clinical procedure for excluding the diagnosis of ankle and midfoot fractures and reducing the number of unnecessary xrays. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. Data sources medline, embase, cinahl, sportdiscus and cochrane library. The ottawa ankle rules were developed and clinically tested to show that they led to a decrease in the use of ankle radiography, waiting times, and costs without. Using the diagram below we can determine when an ankle series is required.
The above research led to a final set of decision rules, named the ottawa ankle rules, for the use of radiography in ankle. Ottawa ankle rules the ottawa ankle rules are simple guidelines developed to aid emergency physicians in deciding when to use radiography for patients with injuries to the ankle. Ottawa ankle rules to exclude fractures of ankle and mid foot. It is the dedication of healthcare workers that will lead us through this crisis.
Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. Essentially, the rules are based on the presence or absence of bony tenderness and the ability or inability to bear weight. National athletic trainers association position statement. Awareness and use of the ottawa ankle and knee rules in 5 countries. Comparison of ottawa ankle rules and bernese ankle rules. The oar is a clinical decision rule that allows clinicians to examine an injured ankle or mid foot and exclude the majority of clinically significant fractures.
Nurse practitioners treating ankle and foot injuries using the ottawa ankle rules a comparative study in the emergency department. Ottaaw knee rule for knee injury radiography stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla. Additionally, north shore foot ankle is not obligated to followup or contact visitors to this site, nor is it liable in any manner for the decisions of visitors whose. The ottawa ankle rules oars are a valid clinical tool to determine the need for radiographs of the acutely injured ankle or midfoot. Effect of the low risk ankle rule on the frequency of.
Ottawa ankle rules an accurate clinical procedure for excluding the diagnosis of ankle and mid foot fractures and reducing the number of unnecessary xrays. 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. 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. Ian stiell and his colleagues developed the ottawa ankle rules 1,2 to facilitate this decision. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. Decision rules for the use of radiography in acute ankle injuries. Below the form you can read more about the rules and their interpretation. Implementation of the ottawa ankle rules jama jama network. Implementation of the ottawa ankle rules by general. Stage 2 validation physicians correctly classified patients according to the ankle and foot decision rules in 99% and 100%. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries.
Oct 15, 20 pediatric ankle injuries result in more than 2 million emergency department visits in canada and the united states each year jeanette tyas, canadian institute of health information. Fractures and dislocations of the ankle and foot are among the most common injuries in the musculoskeletal system. 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. Foot and ankle injuries are common in the emergency department ed. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of an ankle andor foot injury using the ottawa ankle. Ottawa ankle rules calculator this ottawa ankle rules calculator predicts the need for foot xray or ankle imaging in common injuries based on the accurate ottawa foot rules. Ottawa ankle rules ottawa health research institute. Ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf download.
Clinical practice use of the ottawa ankle rule by paramedics. Clinical usefulness of the ottawa ankle rules for detecting fractures of the ankle and midfoot. Clinical evidence, costeffectiveness, and guidelines. They have nearly perfect sensitivity for identifying clinically significant ankle fractures. The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns. Usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. Pdf nurse practitioners treating ankle and foot injuries. The ottawa ankle and foot rules were designed to minimise the number of radiographs needed.
Pdf the sonographic ottawa foot and ankle rules study the. 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. Bone tenderness over the distal 6cm of the posterior edge or tip of the lateral malleolus bone tenderness over the distal. 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. 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. Ankle radiography is required if there is pain in the malleolar zone, and if one of the following is present. Foot rule definition of foot rule by the free dictionary.
Diagnostic performance of the bernese versus ottawa ankle. The oar is a clinical decision rule that allows clinicians to examine an injured ankle or midfoot and exclude the majority of. Pdf validation of the ottawa ankle rules for acute foot. Use of these rules reduced radiographic examinations by 28% for the ankle and 14% for the foot.
Ottawa knee and ankle rules pdf ottawa ankle and foot rules. Implementation of the ottawa ankle rules by general practitioners in the emergency department of a turkish district hospital with a positive test. Objectives the purpose of this study was to assess the. The ottawa ankle rules are physical exam findings that help predict the likelihood of an osseous ankle injury. Background the ottawa ankle rules oar are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography.
Avoids unnecessary diagnostics and xray exposure for the patient while cutting expenses for the system, leaving more resources for patients who actually need the care. The mnemonic 445566pm helps to remember the components of the ottawa ankle and foot rule. Radiographic examinations showed 19 fractures out of 100 investigated patients table 1. We conclude that implementing ottawa ankle rule can identify all clinically relevant fractures of ankle and foot. Interobserver agreement between physicians for ankle and foot decision rules was 56% and 69%. Use of the ottawa ankle rule by paramedics in the outof. 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. 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. Ankle radiographs are suggested if there is pain in the malleolar region with any of the following.
Clinical value of the ottawa ankle rules for diagnosis of. Apr 03, 2008 the mnemonic 445566pm helps to remember the components of the ottawa ankle and foot rule. 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. Ankle radiography is indicated only if a patient has pain in the malleolar zone and any of the following findings. The implementation of the ottawa ankle rules by emergency department physicians. The ottawa ankle rule was derived to aid efficient use of radiography in acute ankle and midfoot injuries. Before the introduction of the rules most patients with ankle injuries would have been imaged. Potential reduction in radiography for ankle and foot series estimated to be 34% and 30%.
Of those requiring radiographs in accordance with the ottawa foot and ankle rules, approximately 22% have a fracture. Prospective validation of a decision rule for the use of radiography in acute knee injuries. The ottawa ankle rules could significantly reduce the need for radiography in patients with acute ankle and midfoot injuries in this setting without missing clinically significant fractures. An ankle xray is required only if there is any pain in malleolar zone and any of these findings.