Accuracy of Ottawa ankle rules for midfoot and ankle injuries

Accuracy of Ottawa ankle rules for midfoot and ankle injuries

Authors

  • Selen Yavas Polatlı State Hospital
  • Engin Deniz Arslan Diskapi Yildirim Beyazit Training and Research Hospital
  • Seda Ozkan Diskapi Yildirim Beyazit Training and Research Hospital
  • Yasemin Yilmaz Aydin Diskapi Yildirim Beyazit Training and Research Hospital
  • Macit Aydin Diskapi Yildirim Beyazit Training and Research Hospital

Keywords:

Ottawa Ankle Rules, Ankle and Midfoot Injuries, X ray, Emergency Department

Abstract

Background

The management of ankle sprains is common practice in emergency departments. Traditionally, physicians would order radiographs for all ankle injuries although the overall incidence of fractures are less than 15% .  The Ottawa Ankle Rules (OAR) have been developed to predict the necessity of radiographs in acute ankle injuries.

Material and Method

This is a prospective study of consecutive patients aged 16 years or older with acute non-penetrating ankle or foot injuries and who had a radiography of ankle or foot or both.

Results

499 cases were included in the study. 56.90 % of the patients were male and the median age of the patients was 30 (IQR  22,44).  22.85 % (114/499) of patients with ankle or midfoot injuries had fractures.  The sensitivity, specificity, PPV and NPV of OAR for ankle and midfoot injuries  were 100, 45.26, 26.00, 100 and 100, 43.71, 19.92 and 100 respectively. In this study 792 x rays were ordered from 499 patients. According to OAR 509  (%64.27) of them were indicated whereas 283 (% 35.73) were not. When the weight bearing test is sole criteria 303 ( 38.26%) x rays were obtained to find out three fractures.

Conclusion

OAR should be safely used in emergency departments. Implantation of this rule prevents patients from unnecessary radiation exposure. It is a reasonable approach to reassess the patient if symptoms not resolve several days later  for avoiding unnecessary x ray exposure when the weight bearing test exist as the only positive criteria.

References

1- Vargish T, Clarke WR, Young RA, Jensen A. The ankle injury: indications for the selective use of x-rays. Injury 1983; 14: 507–12
2- Stother IG. Incidence of minor fractures in twisting injuries of the ankle. Injury 1974; 5: 213–4.
3- Stiell IG, Greenberg GH, McKnight RD et al. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992; 21:(4):384-90.
4- Stiell IG, Greenberg GH, McKnight RD et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993;269(9):1127-32.
5- Lucchesi GM, Jackson RE, Peacock WF et al. Sensitivity of the Ottawa rules. Ann Emerg Med. 1995;26(1):1-5.
6- Lucchesi GM, Jackson RE, Peacock WF, Cerasani C, Swor RA. Sensitivity of the Ottawa rules. Ann Emerg Med. 1995;26(1):1-5.
7- Perry S, Raby N, Grant PT. Prospective survey to verify the Ottawa ankle rules. J Accid Emerg Med. 1999;16(4):258-60)
8- Yuen MC, Sim SW, Lam HS, Tung WK Validation of the Ottawa ankle rules in a Hong Kong ED. Am J Emerg Med. 2001;19(5):429-32)
9- Derksen RJ, Knijnenberg LM, Fransen G, Breederveld RS, Heymans MW, Schipper IB. Diagnostic performance of the Bernese versus Ottawa ankle rules: Results of a randomised controlled trial Injury. 2015 Aug;46(8):1645-9. doi: 10.1016/j.injury.2015.03.038. Epub 2015 Apr 17
10- Broomhead A, Stuart P. Validation of the Ottawa Ankle Rules in Australia. Emerg Med (Fremantle). 2003;15(2):126-32.
11- Can U, Ruckert R, Held U, Buchmann P, Platz A, Bachmann LM. Safety and efficiency of the Ottawa Ankle Rule in a Swiss population with ankle sprains. Swiss Med Wkly. 2008;138(19-20):292-6.
12- Meena S, Gangary SK Validation of the Ottawa Ankle Rules in Indian Scenario. Arch Trauma Res. 2015 20;4(2):e20969.

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Published

02-09-2021

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Section

ORIGINAL ARTICLES

How to Cite

1.
Yavas S, Arslan ED, Ozkan S, Yilmaz Aydin Y, Aydin M. Accuracy of Ottawa ankle rules for midfoot and ankle injuries. Acta Biomed [Internet]. 2021 Sep. 2 [cited 2024 Jul. 18];92(4):e2021241. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/9962