Scoliosis and Ottawa Rules

Question 1

Purpose of Ottawa Ankle Rules

Answer 1

The determine if there is a need for radiographs in acute ankle injuries Helps avoid unnecessary imaging

Question 2

Incidence in ankle sprains between genders

Answer 2

Females have a higher incidence of ankle sprains than males F = 13.6 per 1000 M = 6.94 per 1000 Doherty et al. 2014

Question 3

Who is more likely to sprain their ankle:

children or adolescents

Answer 3

Children

Doherty et al. 2014

Question 4

Who is more likely to sprain their ankle:

adolescents or adults

Answer 4

Adolescents

Doherty et al. 2014

Question 5

Accuracy of Ottawa rules

Answer 5

~100% sensitivity

Modest specificity

When used to exclude fractures of the ankle and mid-foot

Question 6

Ottawa Rules

Answer 6

Question 7

Physical Exam and Treatment Tips for Ottawa Rules

Answer 7

Palpate the entire distal 6 cm of tibia and fibula

Closely examine for medial malleolar tenderness

Only use Ottawa rules if patient is over 18 y/o

Encourage follow up for 5-7 days if pain and walking ability don’t improve

Question 8

Damaged Ligament in an Inversion Ankle Sprain

Answer 8

Calcaneofibular ligament

“Last year we were taught ATF…stupid”

Question 9

Damaged Ligament in an Eversion Ankle Sprain

Answer 9

Deltoid ligament

Question 10

Damaged Ligament in a High Ankle Sprain

Answer 10

Syndesmotic tear

Aka the in

Question 11

Damaged Ligament in a High Ankle Sprain

Answer 11

Syndesmotic tear

aka. interosseus membrane and the fibiofibular ligament

Question 12

Grade 1 Ankle Sprain

Answer 12

Minimal tenderness and swelling

Minimal Impariment

Pathophysiology - microscopic tearing of collagen fibers

Treatment - Weight bear as tolerated, physical therapy

Question 13

Grade 2 Ankle Sprain

Answer 13

Moderate tenderness and swelling

Decreased ROM and possible instability

Moderate impairment

Pathophysiology - Complete tear of some but not all collagen fibers in the ligament

Treatment - Immobilize w/ air splint and PT

Question 14

Grade 3 Ankle Sprain

Answer 14

Significant swelling and tenderness

Instability of joint

Severe impairment

Pathophysiology: Complete tear or rupture of ligament

Treatment: Immobilization, PT, Possible surgical reconstruction

Question 15

Ottawa Rules for the Knee

Answer 15

Should get an X Ray if any criteria below is met

1) > 55 y/o
2) Isolated tenderness to the patella (no bone tenderness othe than patella)
3) Tenderness of head of fibula
4) Inability to flex to 90º
5) Inability to bear weight both immediately and in ED more than 4 steps

Question 16

How do you find Cobb angle?

Answer 16

Find the angle created by a parrellel line coming off the superior surface of the most cephalad vertebra in the curve with the parrellel line coming off the inferior surface of the most caudad vertebra in the curve

Question 17

Classifications of Cobb Angle

Answer 17

Mild = 5-15º

Moderate = 20-45º

Severe = 50º

Question 18

At what angle is respiratory function comprimised?

Answer 18

Cobb angle > 50º

Question 19

What does scoliosis do to rib motion?

Answer 19

Adds a torsional motion