The ottawa rules are a set of clinical decision rules developed by dr. A clinical decision rule to determine the need for diagnostic imaging for ankle andor foot trauma. The ottawa knee rules okrs were first derived and validated in ottawa, canada, with the aim of reducing the number of unnecessary radiographs ordered after knee trauma without compromising patient care. The rules were also associated with a reduction in waiting times and costs. Ottawa ankle rules wikimili, the free encyclopedia. While all of these rules can be used in patients under the age of 18, they should be used with caution. 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. Eligibility criteria for selecting studies primary diagnostic studies. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot. The rules, developed by emergency department physicians at the ottawa hospital and the university of ottawa, are applied to the ankle, knee or. The ottawa ankle rules should be used to rule out fractures and prevent unnecessary.
Can we safely apply the ottawa ankle rules to children. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. Comparison of ottawa ankle rules and bernese ankle rules. Less than 2% of patients in most subgroups who were negative for fracture according to the ottawa ankle rules actually had a fracture. This study compared assessment of suspected ankle and foot injuries using the ottawa ankle rules oar by nps and ed medical doctors eddrs. Nurse practitioners treating ankle and foot injuries using. This video demonstrates the ottawa rules used for ankle and knee injuries and determine whether or not to refer a patient for xray series to diagnose fractures of the ankle and foot, and knee. Pdf application of ottawa ankle rules researchgate. Ottawa ankle rules ottawa hospital research institute. The ottawa rules for ankle, knee and spine now a mobile. Hanley and belfus dowling s, spooner ch, liang y et al.
Ottaaw knee rule for knee injury radiography stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla. What are the ottawa ankle rules and how are they used to. Ottawa knee rule ottawa hospital research institute. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot in. Accuracy of ottawa ankle rules to exclude fractures of the. The aim of this present study was to compare the diagnostic accuracy and reproducibility of 2 clinical decision rules the ottawa knee rules okr and pittsburgh decision rules pdr developed for selective use of xrays in the evaluation of isolated knee trauma.
O ottawa rules for xray of knee, ottawa ankle and foot rules lateral view ankle and foot medial view posterior edge or tip of medial malleolus navicular malleolar zone midfoot zone posterior edge or tip of lateral malleolus base of 5th metatarsal 6cm an ankle xray is required only if there is any pain in malleolar zone and any of these findings. There are three sets of rules, one each for the foot, ankle and knee. Use of the ottawa ankle rule by paramedics in the outof. Pdf ottawa ankle rules and subjective surgeon perception. Prospective validation of a decision rule for the use of radiography in acute knee injuries. Knee rule for knee injury radiography a knee xray series is only required for knee injury patients with any of these findings. They are also careful to point out several groups in whom they do not feel the rules should be applied, such as the intoxicated, the multiply injured, or. Ottawa ankle rules for the injured ankle british journal. Prospectively validated in 1993 by stiell et al, 3 the ottawa ankle rule requires localized bone tenderness of the posterior edge or tip of either malleolus or the inability to bear weight both immediately after the injury or in the ed. 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. Ottawa knee rule the ottawa hospital research institute.
We conclude that implementing ottawa ankle rule can identify all clinically relevant fractures of ankle and foot. Ottawa ankle rule illustration click here to view the illustration on. The ottawa knee rules are highly sensitive at identifying which patients with knee trauma should have an xray to exclude fracture. 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. Multicentre trial to introduce the ottawa ankle rules for use of radiography in acute ankle injuries. The rules have been demonstrated to decrease unnecessary diagnostic imaging.
The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. The ottawa knee rules are a set of rules used to help physicians determine whether an xray of the knee is needed they state that an xray is required only in patients who have an acute knee injury with one or more of the following. Radiographic examinations showed 19 fractures out of 100 investigated patients table 1. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot in children. The ottawa knee rules are considered to have a high sensitivity for fracture, while also reducing the overall number of radiographs obtained in an acute setting. Several studies have examined the effectiveness of the ottawa knee rules, with each reporting the rules leading to a decrease in the use of knee radiography. Bone tenderness at the posterior edge or tip of the lateral malleolus a. The ottawa foot rule was also validated during the same study and requires bone tenderness at the base of the fifth metatarsal, bone tenderness at the.
Pdf abstract ankle injury is a common injury sustained in an outdoor activity or as a sport injury presenting to the emergency department. Epomedicine oct 29, 2017 no comments emergency medicine musculoskeletal system orthopedics radiology. Racgp the ottawa knee rules a useful clinical decision. Tenderness of patella is significant only if an isolated finding. Nurse practitioners nps in the emergency department ed have been trained to assess a range of clinical problems and minor complaints such as acute ankle injury. Awareness and use of the ottawa ankle and knee rules. Bone tenderness at the posterior edge or tip of the medial malleolus b or. Appropriate application of the rules can reduce the number of radiographs performed in the setting of acute knee injuries, with the potential benefits of improved cost efficiency and decreased radiation exposure for the patient.
Diagnostic accuracy and reproducibility of the ottawa knee. Data sources medline, embase, cinahl, sportdiscus and cochrane library. Although they were not originally intended for patients. Use of the ottawa ankle rule by paramedics in the outofhospital setting introduction the ottawa ankle rule oar is extensively documented in the emergency department setting and has been subjected to repeated validation. The ottawa ankle rules are contingent upon the patient presenting within 10 days of the injury. Knowing when to order xrays, or even what to order, can be confusing. 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. An ankle xray is required only if there is any pain in malleolar zone and any of these findings.
Rule out a complete tear of the ligaments by doing drawer testing of the ankle before discharging the patient or at the first followup visit ottawa knee rules a knee xray is only required for knee injury patients with any of these findings. An inability to bear weight both immediately and in the emergency department for four steps. It is the dedication of healthcare workers that will lead us through this crisis. It has been prospectively validated on multiple occasions in. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. A clinical decision rule to determine the need for diagnostic imaging for knee trauma. The ottawa knee rule was derived to aid in the efficient use of radiography in acute knee injuries. Before the introduction of the rules most patients with ankle injuries would have been imaged. 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. A knee xray is only required for knee injury patients with.
Bone tenderness at the posterior edge or tip of the lateral malleolus a or. The ottawa knee rules determine the need for radiographs in acute knee injuries. Key recommendations usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. The applicability of the ottawa ankle rules in children aged 216 years has been confirmed with 100% sensitivity for significant fractures of the ankle and midfoot. Editor,further to previous correspondence i think the use of the ottawa ankle rule needs some clarification. The ottawa knee rule describes criteria for knee trauma patients who are at low risk for clinically significant fracture and do not warrant knee imaging. Imaging is required if there is pain in the midfoot zone and any of the following. Patients who do not meet the fracture predictor of the okrs are highly. This would allow a reduction in radiographs of the ankle of 16% and of the foot by 29%, without missing any clinically significant fracture.
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 ottawa knee rule describes criteria for minor knee trauma patients that are so low risk as not to warrant knee imaging. We summarised the accuracy of the ottawa ankle rules for excluding fractures of the ankle and midfoot in patients presenting to emergency departments with an acute ankle sprain. The ottawa ankle rule was derived to aid efficient use of radiography in acute ankle and midfoot injuries. Effect of triagebased use of the ottawa foot and ankle. The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging. Ottawa foot, ankle and knee rules mnemonic epomedicine. Ottawa ankle rules the ottawa hospital research institute. Ottawa ankle rules an overview sciencedirect topics. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. An ankle xray series is only required if there is any pain in the malleolar zone and.
The most important step in ankle fracture management is identifying stable verses unstable fractures. The ottawa knee rules are useful in ruling out fracture high sensitivity when negative, but poor for ruling in fractures many false positives. Pdf abstract ankle injury is a common injury sustained in an outdoor activity or. Weightbearing inability was the ottawa ankle rule item that presented the highest reliability, 69. A knee xray series is only required for knee injury patients with any of these findings. Ian stiell and his research team at the ottawa hospital research institute and the university of ottawa. Diagnostic accuracy of the ottawa ankle and midfoot rules. Ottawa ankle rules last updated december 03, 2019 ligaments of the ankle 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. Sensitivity and specificity of oar were 100% and 77% respectively.
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