Ottawa Ankle Rules

Question 1

An ankle x-ray series is only required if there is any pain in malleolar zone and any of these three findings:

Answer 1

1.bone tenderness at posterior edge of lateral malleolus

2.bone tenderness at posterior edge or tip of medial malleolus

3. Inability to bear weight both immediately and in ED (emergency department)

Question 2

A foot x-ray series is only required if there’s any pain in midfoot zone and any of these findings:

Answer 2

1. Bone tenderness at base of 5th metatarsal
2. Bone tenderness at navicular
3. Inability to bear weight both immediately and in ED (emergency department)

Question 3

What are some considerations that should be taken to apply the Ottawa ankle rules accurately?

Answer 3

• palpate the entire distal 6 cm of the fibula and tibia
• Do not neglect the importance of medium malleolar tenderness
• Do not use for patients under age 18

Question 4

Clinical judgement should prevail over the rules if the patient:

Answer 4

• is intoxicated or uncooperative
• Has other distracting painful injuries
• diminished sensation in the legs
• Has gross swelling, which prevents palpation of malleolar bone tenderness

Question 5

If pain, inability to walk are not better in 5 to 7 days…

Answer 5

Encourage follow up (Give written instructions to do so before discharge)