Ottawa ankle and foot rules

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

A foot x-ray is required if there is any pain in the midfoot zone and any of these findings:

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 97.8% and a specificity of 31.5%, giving a negative likelihood ratio of 0.07; this will yield a post-test probability of about 1% for fracture of the ankle if test results are negative (not requiring x ray)
Treatment for ligament injuries should include dynamic splinting and RICE (rest, ice, compression, and elevation)
Rule out a complete tear of the ligaments by doing drawer testing of the ankle before discharging the patient or at the first follow-up visit

 

 

Ottawa knee rules

A knee x-ray is only required for knee injury patients with any of these findings:


Source: BMJ 1995, Bandolier 1998. BMJ 2009