2. Ottawa Rules

Question 1

What are the Ottawa Ankle Rules?

Answer 1

Screening to determine need for XR in acute ankle injuries

Question 2

Why was Ottawa Rules devleoped?

Answer 2

Rapid and accurate way to avoid unncessary imaging

Question 3

Ottawa ankle rules excludes fractures of what

Answer 3

ankle and midfoot

Question 4

What is senstivity and specifity of Ottawa rules?

Answer 4

• Sensitivity: 100%
• Specificity: modest

Question 5

Inversion fracture of the foot damages ________

Answer 5

calcaneofibular

Question 6

Eversion fracture of the foot damages ________

Answer 6

Deltoid ligament

Question 7

High ankle fracture of the foot causes ________

Answer 7

Syndesmotic tear

Question 8

How do we grade ankle sprains?

Answer 8

Grade 1, 2 and 3

Question 9

Grade 1 ankle sprain

PE:

Impairment:

Path:

Tx:

Answer 9

PE: minimal tenderness and swelling

Impairment: minimal

Path: microscopic tear of collagen fibers

Tx: Weight bear as tolerated, PT

Question 10

Grade 2 ankle sprain

PE:

Impairment:

Path:

Tx:

Answer 10

PE:

• moderate tenderness and swelling
• decreased ROM
• Possible instability

Impairment: moderate

Path: complete tears of SOME collagen fibers in ligament

Tx: immobilize w air splint, PT

Question 11

Grade 3 ankle sprain

PE:

Impairment:

Path:

Tx:

Answer 11

PE: significant swelling and tenderness/instability

Impairment: severe

Path: complete tear of ligament

Tx: immobile, PT, possible surgery

Question 12

What are the Ottawa ankle rules

Answer 12

Perform a XR of ankle if there is pain in the malleolar region + any of the following:

1. Bone tenderness @ [posterior edge of the distal 6cm] or [tip] of lateral malleous
2. Bone tenderness @ [posterior edge of the distal 6cm] or [tip] of the medial mallelus
3. Cannot bear weight for 4 steps BOTH [immediately after injury] & [when evaluated]

Question 13

What are the Ottawa Foot rules

Answer 13

Perform a XR of foot if there is pain in the midfoot region + any of the following:

• 1. Tender naviular bone
• 2. Tenderness base of the 5th metatarsal
• 3. Cannot bear weight for 4 steps BOTH [immeditely after injury] and [when evaluated]

Question 14

What important things to consider when using Ottakwa ankle rules?

Answer 14

1. Only use on pts over 18
2. Palpate ENTIRE distal 6cm of tibia + fibia
3. Do not ignor tender medial malleolos

Question 15

What should we do if ottwa rules determines patient does NOT need an XR?

Answer 15

1. Give written instruction
2. F/U in 5-7 days if pain and walking ability has not improved

Question 16

Ottawa knee rules (5)

Answer 16

Do a knee XR for knee injury pts if:

1. > 55YO
2. Isolated tenderpatella (& no other bone is tender)
3. Tender fibular head
4. Cannot flex to 90 degrees
5. Cannot bear weight fo 4 steps both immediately after and in ED