Ottawa Ankle Rules: Difference between revisions
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'''Original Editor '''- [[User:Jill Nicole Hickey|Jill Nicole Hickey]] | '''Original Editor '''- [[User:Jill Nicole Hickey|Jill Nicole Hickey]] | ||
'''Lead Editors''' - | '''Lead Editors''' - [[User:Evan Thomas|Evan Thomas]] | ||
</div> | </div> | ||
== Purpose: == | == Purpose: == | ||
To determine the need for x-rays after an acute ankle injury.<ref name="Stiell et al 1993">Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Reardon M, Stewart JP, Maloney J. Decision rules for the use of radiography in acute ankle injuries. JAMA 1993;269:1127-32.</ref> | To determine the need for x-rays after an acute ankle injury.<ref name="Stiell et al 1993">Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Reardon M, Stewart JP, Maloney J. Decision rules for the use of radiography in acute ankle injuries. JAMA 1993;269:1127-32.</ref> | ||
== Variables:<ref name="Stiell et al 1994">Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa Ankle Rules. JAMA 1994;271:827-32.</ref> == | == Variables:<ref name="Stiell et al 1994">Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa Ankle Rules. JAMA 1994;271:827-32.</ref> == | ||
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<br> Figure 1. Palpation locations within the malleolar and midfoot zones. (Image from CDR Ankle Poster<ref>http://www.ohri.ca/emerg/cdr/docs/cdr_ankle_poster.pdf</ref>) | <br> Figure 1. Palpation locations within the malleolar and midfoot zones. (Image from CDR Ankle Poster<ref>http://www.ohri.ca/emerg/cdr/docs/cdr_ankle_poster.pdf</ref>) | ||
<br> A. Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus | <br> A. Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus | ||
B. Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus | B. Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus | ||
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D. Bony tenderness at the navicular | D. Bony tenderness at the navicular | ||
E. Inability to bear weight both immediately after injury and for 4 steps during intial evaluation | E. Inability to bear weight both immediately after injury and for 4 steps during intial evaluation | ||
== Method of Use:<ref name="Stiell et al 1994">Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa Ankle Rules. JAMA 1994;271:827-32.</ref> == | == Method of Use:<ref name="Stiell et al 1994">Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa Ankle Rules. JAMA 1994;271:827-32.</ref> == | ||
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http://www.ohri.ca/emerg/cdr/ankle_rule_flash.html | http://www.ohri.ca/emerg/cdr/ankle_rule_flash.html | ||
An ankle x-ray series is only required if there is pain in the malleolar zone AND any of variables A OR B OR E. | An ankle x-ray series is only required if there is pain in the malleolar zone AND any of variables A OR B OR E. | ||
A foot x-ray series is only required if there is pain in the midfoot zone AND any of variables C OR D OR E. | A foot x-ray series is only required if there is pain in the midfoot zone AND any of variables C OR D OR E. | ||
== Recommendations:<ref name="Stiell et al 1994">Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa Ankle Rules. JAMA 1994;271:827-32.</ref> == | == Recommendations:<ref name="Stiell et al 1994">Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa Ankle Rules. JAMA 1994;271:827-32.</ref> == | ||
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3. Using the rules only on those over the age of 18 | 3. Using the rules only on those over the age of 18 | ||
<br> Be sure to give written instructions and encourage follow-up in 5-7 days if pain and walking ability have not improved. | <br> Be sure to give written instructions and encourage follow-up in 5-7 days if pain and walking ability have not improved. | ||
== Evidence: == | == Evidence: == | ||
A systematic review of 27 studies by Bachmann et al 2003 found the pooled sensitivity of the Ottawa Ankle Rules to be 97.6%, with a median specificty of 31.5%. The pooled negative likelihood ratio was determined to be 0.10.<ref name="Bachmann et al 2003">Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: Systematic review. BMJ 2003;326:417-23.</ref><br> | A systematic review of 27 studies by Bachmann et al 2003 found the pooled sensitivity of the Ottawa Ankle Rules to be 97.6%, with a median specificty of 31.5%. The pooled negative likelihood ratio was determined to be 0.10.<ref name="Bachmann et al 2003">Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: Systematic review. BMJ 2003;326:417-23.</ref><br> | ||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]): == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]): == | ||
Revision as of 00:43, 29 March 2013
Original Editor - Jill Nicole Hickey
Lead Editors - Evan Thomas
Purpose:[edit | edit source]
To determine the need for x-rays after an acute ankle injury.[1]
Variables:[2][edit | edit source]
Figure 1. Palpation locations within the malleolar and midfoot zones. (Image from CDR Ankle Poster[3])
A. Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus
B. Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus
C. Bony tenderness at the base of 5th metatarsal
D. Bony tenderness at the navicular
E. Inability to bear weight both immediately after injury and for 4 steps during intial evaluation
Method of Use:[2][edit | edit source]
http://www.ohri.ca/emerg/cdr/ankle_rule_flash.html
An ankle x-ray series is only required if there is pain in the malleolar zone AND any of variables A OR B OR E.
A foot x-ray series is only required if there is pain in the midfoot zone AND any of variables C OR D OR E.
Recommendations:[2][edit | edit source]
Ensure to apply the Ottawa Ankle Rules accurately by...
1. Palpating the entire distal 6cm of the tibia and fibula
2. Not neglecting the importance of medial malleolar tenderness
3. Using the rules only on those over the age of 18
Be sure to give written instructions and encourage follow-up in 5-7 days if pain and walking ability have not improved.
Evidence:[edit | edit source]
A systematic review of 27 studies by Bachmann et al 2003 found the pooled sensitivity of the Ottawa Ankle Rules to be 97.6%, with a median specificty of 31.5%. The pooled negative likelihood ratio was determined to be 0.10.[4]
Recent Related Research (from Pubmed):[edit | edit source]
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References:[edit | edit source]
- ↑ Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Reardon M, Stewart JP, Maloney J. Decision rules for the use of radiography in acute ankle injuries. JAMA 1993;269:1127-32.
- ↑ 2.0 2.1 2.2 Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa Ankle Rules. JAMA 1994;271:827-32.
- ↑ http://www.ohri.ca/emerg/cdr/docs/cdr_ankle_poster.pdf
- ↑ Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: Systematic review. BMJ 2003;326:417-23.
