Lightning Learning: Ottawa Ankle Rules

Lightning Learning: Ottawa Ankle Rules

“Does your patient really need that ankle x-ray? Luckily there is a handy ruleset that can help you decide!”
— advice is based on local guidelines & procedures
 
Lightning Learning - Ottawa Ankle Rules (Poster).png
 

What?

Ankle x-ray if pain in Malleolar zone, and any of…

  • Bone tenderness – distal 6cm of posterior edge of the tibia or tip of medial malleolus.

  • Bone tenderness – distal 6cm of posterior edge of the fibula or tip of lateral malleolus.

  • Unable to weight bear immediately and in the department for 4 steps.

Foot x-ray if pain in mid-foot and…

  • Bone tenderness at base of 5th metatarsal

  • Bone tenderness at navicular bone

  • Unable to weight bear immediately and in the department for 4 steps.

Why?

The Ottawa Ankle Rules are a validated tool to identify those needing ankle/foot x-rays. They are sensitive (i.e. can rule out fractures), but are not overly specific (i.e. there will be false positives).

Using the rules can reduce the number of unnecessary x-rays by up to 30%

There are limitations:

  • Intoxicated or uncooperative patients

  • Distracting painful injuries

  • Poor sensation in the legs

  • Gross swelling preventing palpation of bone tenderness

They can also be applied to children with some caveats (see links in Further Reading)
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