Ottawa ankle rules 3208465 210529544 2008-05-06T09:12:50Z Thijs!bot 1392310 robot Adding: [[nl:Ottawa ankle rules]] [[Image:Gray355.png|thumb|300px|Ligaments of the [[ankle]].]] In [[medicine]], the '''Ottawa ankle rules''' are a set of guidelines for [[physician|doctor]]s to aid them in deciding if a patient with [[foot]] or [[ankle]] pain should be offered [[X-ray]]s to diagnose a possible [[bone fracture]]. Before the introduction of the rules most patients with ankle injuries would have been [[x-ray|X-rayed]]. However only about 15% of X-rays were positive for fracture, other patients had [[sprain]]s or other injuries. As a result many unnecessary X-rays were taken, which was costly, time consuming and a possible health risk. ==The Ottawa ankle rules== X-rays are only required if there is bony pain in the malleolar or midfoot area, and any one of the following: * Bone tenderness along the [[anatomical terms of location|distal]] 6&nbsp;cm of the posterior edge of the [[tibia]] or tip of the [[medial malleolus]] * Bone tenderness along the distal 6&nbsp;cm of the [[anatomical terms of location|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. Certain groups are excluded, in particular [[child]]ren (under the age of 18), [[pregnant]] women, and those with diminished ability to follow the test (for example due to [[head injury]] or [[intoxication]]). ==Utility of the Ottawa rules== The rules have been found to have a very low rate of [[Type I and type II errors|false negative]]s. In the original research reported that the test was 100% [[Sensitivity (tests)|sensitive]] and reduced the number of ankle X-rays by about 35%.<ref name=stiell_1554175>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. PMID 1554175.</ref> A second trial with a larger number of patients confirmed these findings.<ref name=stiell_8114236>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. PMID 8114236.</ref> Subsequently, a multi-centre study was done that explored the feasibility of implementing the rules on a wider scale.<ref>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. PMID 7663253. [http://bmj.bmjjournals.com/cgi/content/full/311/7005/594 Full Text].</ref> ==Generalization to other joints== The original rules were developed for ankle and foot injuries only, but similar guidelines have been developed for other injuries such as the knees. ==History== The Ottawa ankle rules were developed by a team at the department of [[emergency medicine]] in [[Ottawa]], [[Canada]].<ref name=stiell_1554175/> Since the rules were formulated in Ottawa they were dubbed the ''Ottawa ankle rules'' by its creators a few years after their development, a title that has stuck.<ref name=stiell_8114236/> In this respect, the naming of the rules is similar to a widely used assessment of mental status, the [[Glasgow Coma Scale]] (GCS), which also takes its name from the city in which it was created. ==References== <references/> ==External links== * [http://www.jr2.ox.ac.uk/bandolier/band49/b49-2.html Ottawa Knee Rules] - [[Bandolier (journal)|Bandolier]] an independent journal about [[evidence-based medicine]]. * [http://www.gp-training.net/rheum/ottawa.htm Ottawa rules for x-ray of knee, ankle and foot] (graphical explanation). [[Category:Emergency medicine]] [[Category:Bone fractures]] [[Category:Traumatology]] [[nl:Ottawa ankle rules]]