Analogous rules have been formulated for knee and head injuries. Exclusions less than 18 years old intoxication multiple painful injuries pregnant head injury diminished sensation due to neurological deficit recommendations. The ottawa ankle and foot rules to image or not to. Prospective study with historical control group of all children aged 115 years presenting to sheffield childrens hospital accident and emergency department with blunt ankle andor midfoot injuries during two five month periods before. The ottawa ankle rules show areas of tenderness to be evaluated in patients with ankle trauma to determine need for imaging. Background the ottawa ankle rules oar are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. Mar 09, 2015 ottawa ankle rules in 75 seconds duration. A knee xray is only required for knee injury patients with any of these findings. Unable to transfer weight twice onto each lower limb regardless of limping. Comparison of ottawa ankle rules and bernese ankle rules in acute ankle and midfoot injuries article pdf available in turkish journal of emergency medicine 10 january 2010 with 3,121 reads. Use of the ottawa ankle rule by paramedics in the outof. Ankle radiography is indicated only if a patient has pain in the malleolar zone and any of the following findings.
The ottawa ankle rules oar is a validated clinical decision rule for reliably. Xray requesting patterns before and after introduction of the ottawa knee rules in a uk emergency department. 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. Palpate the entire distal 6 cm of the fibula and tibia. Essentially, the rules are based on the presence or absence of bony tenderness and the ability or inability to bear weight. To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. 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. Although the majority of ankle injuries are radiographed, fewer than 15 percent of these patients are found to have fractures of the ankle or foot. Implementation of the ottawa ankle rules jama jama network.
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. The ottawa ankle rule oar is extensively documented in the emergency department setting and has been subjected to repeated validation. 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. The ottawa ankle rules are physical exam findings that help predict the likelihood of an osseous ankle injury.
Rules have been prospectively validated on multiple occasions. Using the ottawa ankle rules, xray imaging can be reduced 34% for the ankle series and 30% for the foot series. However, these patients are almost always referred for radiography. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. All 2342 adults seen with acute ankle injuries during 5month periods before and after the. Racgp the ottawa knee rules a useful clinical decision.
Interobserver agreement in the examination of acute ankle injury patients. Implementation of the ottawa ankle rules by nurses working in an accident and emergency department. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot. Validation of the ottawa ankle rules in children with ankle injuries. In the second stage, the refined rules proved to have sensitivities of 1. Recursive partitioning of 20 predictor variables yielded refined decision rules for ankle and foot radiographic series. Before the introduction of the rules most patients with ankle injuries would have been imaged. Unable to bear weight both immediately and in the emergency room department for 4 steps. Ottawa ankle rules xray for acute injury of the ankle or mid. Nonrandomized, controlled trial with beforeafter and concurrent controls.
Future studies should address the generalizability of these decision rules in a variety of hospital settings. Implementation of the ottawa ankle rules by resident orthopaedic. Hanley and belfus dowling s, spooner ch, liang y et al. Rigorous application of the oars have resulted in a 30% to 40% reduction in unnecessary xrays, while retaining nearly 100% sensitivity ottawa ankle rules, oar practice guidelines developed in canada in 1992 to reduce the number. Ottawa ankle rules an overview sciencedirect topics. 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. Implementation of the ottawa ankle rules by general. Ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf download. Ottawa ankle rules for excluding ankle and midfoot fractures does the patient have. How to fix forward head posture 3 easy exercises from a chiropractor. Emergency departments of a university intervention hospital and a community control hospital. Clinical usefulness of the ottawa ankle rules for detecting fractures of the ankle and midfoot.
Ottawa knee and ankle rules pdf ottawa ankle and foot rules. Objectives the purpose of this study was to assess the. The oar is a clinical decision rule that allows clinicians to examine an injured ankle or mid. Ottawa ankle rules help rule out fractures in children with ankle and. Ottawa ankle rules ottawa hospital research institute. 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. Eu competition law rules applicable to merger control european. However the vast majority of patients with unclear ankle injuries do not have bone fractures. Ottawa ankle rules for the injured ankle pubmed central pmc. Ankle radiography is required if there is pain in the malleolar zone, and if one of the following is present. To assess the impact on clinical practice of implementing the ottawa ankle rules. Use of these rules reduced radiographic examinations by 28% for the ankle and 14% for the foot.
Ottawa ankle rules definition of ottawa ankle rules by. The ottawa ankle rules oars have been designed to reduce the number of unnecessary radiographs ordered for these. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of. The ankle is a complex joint which is capable of a wide range of movement. We validated oar in100 patients in 1stphase and in the 2nd phase we implemented the clinical decision rule of ottawa ankle rule oar. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Bone tenderness at the posterior edge or tip of the lateral malleolus a. 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. Tenderness of patella is significant only if an isolated finding. Criteria ottawa knee rules xray for acute injury of the knee. Do not neglect the importance of medial malleolar tenderness. The ottawa ankle rules modified buffalo rule the buffalo rule was derived to increase the diagnostic accuracy of the ottawa ankle rules, with the point tenderness criterion directed to the crest or midportion of the malleoli distal 6 cm of the fibula and tibia, reducing the likelihood of palpating over injured ligament structures. Radiographic examinations showed 19 fractures out of 100 investigated patients table 1. Validity of the ottawa rules for xray request in ankle.
Comparison of ottawa ankle rules and bernese ankle rules. Bone tenderness over the distal 6cm of the posterior edge or tip of the lateral malleolus. Usethe ottawa ankle rules oar to exclude fractures and reduce unnecessary imaging. Ottawa ankle rules this guideline will aid you in determining which patients require an xray of their ankle. There are two components, assessing for ankle and midfoot fractures. 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. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot in children. Usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. Clinical value of the ottawa ankle rules for diagnosis of. Since the publication of this study, the ottawa ankle rule have been well validated and have been shown to limit the number of radiographs obtained for ankle injuries, decreased patient wait times and cost. To assess whether the ottawa ankle rules can be used to accurately predict which children with ankle and midfoot injuries need radiography.
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. It is imperative to rule out a fracture after an acute ankle trauma. The ottawa ankle rule was derived to aid in the efficient use of radiography in acute ankle and midfoot injuries. The mnemonic 445566pm helps to remember the components of the ottawa ankle and foot rule. Comparison of ottawa ankle rules and bernese ankle rules in. Awareness and use of the ottawa ankle and knee rules in 5 countries. They have nearly perfect sensitivity for identifying clinically significant ankle fractures. The aim of this study was to assess the oar when applied in a german emergency department.
Update on acute ankle sprains american family physician. Below the form you can read more about the rules and their interpretation. Ottawa ankle rules an accurate clinical procedure for excluding the diagnosis of ankle and midfoot fractures and reducing the number of unnecessary xrays. 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.
The ottawa ankle rules oars have been designed to reduce the number of unnecessary radiographs ordered for these patients. Ottowa rules definition of ottowa rules by medical dictionary. 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. Weightbearing inability was the ottawa ankle rule item that presented the highest reliability, 69. The ottawa ankle rules are a set of criteria that are designed to help clinicians identify which patients that present with acute ankle injuries require imaging. 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. Sensitivity and specificity of oar were 100% and 77% respectively.
Decision rules for the use of radiography in acute ankle. Since the rules were formulated in ottawa they were dubbed the ottawa ankle rules by their creators a few years after their development, a title that has stuck. The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging. 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 group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. The ottawa ankle rules were established to help physicians decide which patients should have an xray following an acute ankle injury. Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. Decision rules for the use of radiography in acute ankle injuries. Pmc free article bachmann lucas m, kolb esther, koller michael t, steurer johann, ter riet gerben. Ottowa rules definition of ottowa rules by medical. Pmc free article plint ac, bulloch b, osmond mh, stiell i, dunlap h, reed m, tenenbein m, klassen tp. Ottawa ankle rules xray for acute injury of the ankle or. Ottawa ankle rules ottawa health research institute. The oar have been proven that their application reduces unnecessary radiography. 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. Following the criteria of the ottawa ankle rules oar fractures could be ruled out with a sensitivity of 100% and a specificity of 50% while reducing radiographs by 28%. After an acute ankle trauma it is important to rule out a fracture.
Pdf comparison of ottawa ankle rules and bernese ankle. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. An ankle xray series is only required if there is any pain in the malleolar zone and. The rules appear on the front page of this document. The ottawa ankle rule was derived to aid efficient use of radiography in acute ankle and midfoot injuries. Prospective validation of a decision rule for the use of radiography in acute knee injuries. Racgp the ottawa knee rules a useful clinical decision tool.
Stiell ig, greenberg gh, mcknight rd, nair rc, mcdowell i, reardon m, stewart jp, maloney j. Jun 15, 2012 ankle sprains should be evaluated using the ottawa ankle rules figure 2 3, which are wellestablished clinical guidelines used to determine the need for radiography. Clinical practice use of the ottawa ankle rule by paramedics. Expert opinion in the multicentre trial to introduce the ottawa ankle rules for use of radiography in acute ankle injuries stiell et al, 1995a and the guideline for the radiography of the ankle and foot ottawa ankle rules alberta medical association, 2007 is that a person with an ankle or foot injury should be advised to seek medical help.
The objective of this study is to identify evidence of any level describing the use of the oar by. Stable fractures will have only one break in the supporting ankle ring, whereas unstable. Rules out clinically significant foot and ankle fractures to reduce use of xray imaging. The ottawa ankle rule is useful for ruling out fracture high sensitivity, but poor for ruling in fractures many false positives. Ottaaw knee rule for knee injury radiography stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla. Acute ankle injuries are one of the most common reasons for presenting to emergency departments, but only a small percentage of patients approximately 15% have clinically significant fractures. An ankle xray is required only if there is any pain in malleolar zone and any of these findings. However, the prehospital experience in implementing this clinical decision rule appears poorly described. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. 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. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. 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. 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. Apr 03, 2008 the mnemonic 445566pm helps to remember the components of the ottawa ankle and foot rule.
Ottawa rules simplify the management of ankle injuries. Diagnosis historically imaging is ordered for most patients presenting with an ankle andor midfoot injury even though only about 15%. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. Diagnostic performance of the bernese versus ottawa ankle. Acm pijnenburg thesis research explorer universiteit van. A set of guidelines to help doctors decide if a patient with foot or ankle pain should be xrayed to rule out bone fracture. This list of rules was published in 1992 by a team of doctors in the emergency department of the ottawa civic hospital in ottawa, canada. 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.