Implementation of the ottawa ankle rules by resident orthopaedic. 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 rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging. The ottawa ankle and foot rules to image or not to. Pediatric ankle injuries result in more than 2 million emergency department visits in canada and the united states each year jeanette tyas, canadian institute of health information. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of an ankle and or foot injury using the ottawa ankle. Sensitivity and specificity of oar were 100% and 77% respectively. An ankle xray is required only if there is any pain in malleolar zone and any of these findings. The ottawa ankle rules were developed and clinically tested to show that they led to a decrease in the use of ankle radiography, waiting times, and costs without.
Awareness and use of the ottawa ankle and knee rules in 5 countries. The oar is a clinical decision rule that allows clinicians to examine an injured ankle or midfoot and exclude the majority of. The ottawa ankle rules could significantly reduce the need for radiography in patients with acute ankle and midfoot injuries in this setting without missing clinically significant fractures. The ottawa ankle rules are physical exam findings that help predict the likelihood of an osseous ankle injury. Use of these rules reduced radiographic examinations by 28% for the ankle and 14% for the foot. Rules have been prospectively validated on multiple occasions. Diagnostic accuracy of the ottawa ankle and midfoot rules. Usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. Eligibility criteria for selecting studies primary diagnostic studies reporting. 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. Pdf nurse practitioners treating ankle and foot injuries. A foot xray series is only required if there is any pain the midfoot zone and. Ottawa ankle rules an overview sciencedirect topics. It is the dedication of healthcare workers that will lead us through this crisis.
What is the clinical evidence for the accuracy of the ottawa ankle rules to determine the need for x rays to identify potential bone fracture. Before the introduction of the rules most patients with ankle injuries would have been imaged. Stage 2 validation physicians correctly classified patients according to the ankle and foot decision rules in 99% and 100%. We use rules like the ottawa ankle rules all the time. Decision rules for the use of radiography in acute ankle injuries. Of those requiring radiographs in accordance with the ottawa foot and ankle rules, approximately 22% have a fracture. Stress radiography is an unreliable tool to detect acute ligamentous disruption after ankle sprain. Implementation of the ottawa ankle rules by general.
A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. Use of the ottawa ankle rule by paramedics in the outof. Essentially, the rules are based on the presence or absence of bony tenderness and the ability or inability to bear weight. Oct 10, 2016 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. Ottawa ankle rules and subjective surgeon perception to evaluate. 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.
Patients waited less, were not dissatisfied with their treatment, and significant fractures did not go undetected. The ottawa ankle and foot rules were designed to minimise the number of radiographs needed. Ottawa ankle rules the ottawa ankle rules are simple guidelines developed to aid emergency physicians in deciding when to use radiography for patients with injuries to the ankle. 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. The oar is a clinical decision rule that allows clinicians to examine an injured ankle or mid foot and exclude the majority of clinically significant fractures.
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. Foot rule definition of foot rule by the free dictionary. Specificity represents the number of patients without the condition and. The ottawa ankle rule was derived to aid efficient use of radiography in acute ankle and midfoot injuries. Bone tenderness over the distal 6cm of the posterior edge or tip of the lateral malleolus bone tenderness over the distal. Clinical value of the ottawa ankle rules for diagnosis of. Ottawa ankle rules canadian chiropractic specialty college of.
Analogous rules have been formulated for knee and head 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. Ottowa ankle and foot rules ankle radiographs are only required if there is pain in the malleolar area and any one of the following. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns. Pdf validation of the ottawa ankle rules for acute foot. Ankle radiographs are suggested if there is pain in the malleolar region with any of the following. Ottawa knee and ankle rules pdf ottawa ankle and foot rules. Ottawa ankle rules an accurate clinical procedure for excluding the diagnosis of ankle and mid foot fractures and reducing the number of unnecessary xrays.
Ankle radiography is indicated only if a patient has pain in the malleolar zone and any of the following findings. We conclude that implementing ottawa ankle rule can identify all clinically relevant fractures of ankle and foot. To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. Radiographic examinations showed 19 fractures out of 100 investigated patients table 1. Proportions of patients referred for standard ankle and foot radiographic series. Ankle radiography is required if there is pain in the malleolar zone, and if one of the following is present. Pdf the sonographic ottawa foot and ankle rules study the. The above research led to a final set of decision rules, named the ottawa ankle rules, for the use of radiography in ankle. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. National athletic trainers association position statement.
Ottawa ankle rules to exclude fractures of ankle and mid foot. Objectives the purpose of this study was to assess the. 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. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot.
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. Clinical evidence, costeffectiveness, and guidelines. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. Nurse practitioners treating ankle and foot injuries using the ottawa ankle rules a comparative study in the emergency department. The need for need for radiography is reduced by 36% saving patients money and time. Implementation of the ottawa ankle rules jama jama network.
Rules out clinically significant foot and ankle fractures to reduce use of xray imaging. Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. Additionally, north shore foot ankle is not obligated to followup or contact visitors to this site, nor is it liable in any manner for the decisions of visitors whose. Ottawa ankle rules ottawa health research institute. Racgp the ottawa knee rules a useful clinical decision tool. Ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf download. Oct 15, 20 pediatric ankle injuries result in more than 2 million emergency department visits in canada and the united states each year jeanette tyas, canadian institute of health information.
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. They have nearly perfect sensitivity for identifying clinically significant ankle fractures. 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. Ottawa ankle rules an accurate clinical procedure for excluding the diagnosis of ankle and midfoot fractures and reducing the number of unnecessary xrays. 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. Clinical practice use of the ottawa ankle rule by paramedics. Table 1 shows the calculations for a cohort of 1,000 persons, in whom there were 100 actual fractures, applied to the best, average. Update on acute ankle sprains american family physician. The ottawa ankle rules were established to help physicians decide which patients should have an xray following an acute ankle injury. Prospective validation of a decision rule for the use of radiography in acute knee injuries. Ottaaw knee rule for knee injury radiography stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla. Comparison of ottawa ankle rules and bernese ankle rules in. Ian stiell and his colleagues developed the ottawa ankle rules 1,2 to facilitate this decision. Clinical usefulness of the ottawa ankle rules for detecting fractures of the ankle and midfoot.
The implementation of the ottawa ankle rules by emergency department physicians. Ottawa ankle rules definition of ottawa ankle rules by. Background the ottawa ankle rules oar are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. Below the form you can read more about the rules and their interpretation. Xray requesting patterns before and after introduction of the ottawa knee rules in a uk emergency department. Diagnostic performance of the bernese versus ottawa ankle. Ottawa ankle rules to exclude fractures of ankle and midfoot.
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 rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. The mnemonic 445566pm helps to remember the components of the ottawa ankle and foot rule. Fractures and dislocations of the ankle and foot are among the most common injuries in the musculoskeletal system. All 2342 adults seen with acute ankle injuries during 5month periods before and after the intervention. Avoids unnecessary diagnostics and xray exposure for the patient while cutting expenses for the system, leaving more resources for patients who actually need the care. 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. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot in children.
Foot and ankle injuries are common in the emergency department ed. Mar 06, 20 how to use the ottawa ankle and foot rule. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. 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. Data sources medline, embase, cinahl, sportdiscus and cochrane library. 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. This guideline makes recommendations for adults aged. Implementation of the ottawa ankle rules by general practitioners in the emergency department of a turkish district hospital with a positive test. The north shore foot ankle group makes no claims, expressed or implied as to the accuracy and timeliness of any advice, services, or other information referenced in the website. The ottawa ankle rules oars are a valid clinical tool to determine the need for radiographs of the acutely injured ankle or midfoot. Apr 03, 2008 the mnemonic 445566pm helps to remember the components of the ottawa ankle and foot rule. Interobserver agreement between physicians for ankle and foot decision rules was 56% and 69%. Foot and ankle injuries are frequent in emergency departments.
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