The ottawa knee rule in academic emergency departments eds, and. Appropriate application of the rules can reduce the number of radiographs performed in the setting of acute knee injuries, with the potential benefits of improved cost efficiency and decreased radiation exposure for the patient. More recent evidence also supports the ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and midfoot. Comparison of ottawa ankle rules and bernese ankle rules. A foot xray series is only required if there is any pain the midfoot zone. Objective the ottawa ankle rules oar are criteria for predicting ankle fractures in adults allowing for insignificant fractures, defined as small avulsion fractures. The ottawa ankle rules were initially devised to include age greater than 55 years as a criterion for radiography. Evidence supports the ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and midfoot. The objectives of this study were to assess physician knowledge of, barriers to implementation of, and compliance with the ottawa knee rule in academic emergency departments eds, and.
Ottawa foot, ankle and knee rules mnemonic epomedicine. This article describes the ottawa knee rules and outlines their sensitivity. An ankle xray series is only required if there is any pain in the malleolar zone and. The ottawa ankle rules have a high sensitivity for.
The ottawa knee rules are highly sensitive at identifying which patients with knee trauma should have an xray to exclude fracture. This would allow a reduction in radiographs of the ankle of 16% and of the foot by 29%, without missing any clinically significant fracture. The ottawa ankle rule project demonstrated that more than 95% of patients with ankle injuries had radiographic examinations but that 85% of the films showed no fractures. The ottawa ankle rules are contingent upon the patient presenting within 10 days of the injury. Ottawa ankle rules for the injured ankle british journal. The ottawa knee rules are a set of rules used to help physicians determine whether an xray of the knee is needed. Ottawa knee rule of 98% to 100% for clinically significant knee fractures.
The ottawa ankle rules modified buffalo rule the buffalo rule was derived to increase the diagnostic accuracy of the ottawa ankle rules, with the point tenderness criterion directed to the crest or midportion of the malleoli distal 6 cm of the fibula and tibia, reducing the likelihood of palpating over injured ligament structures. Use only for injuries ottawa knee rules determine the need for radiographs in acute knee injuries. The ottawa ankle rules were established to help physicians decide which. Ottawa knee rule ottawa hospital research institute. The ottawa knee rules provide guidance on how to identify which cases of knee. Validation of the ottawa knee rules pdf free download. Ankle rules for ankle injury radiography a an ankle xray series is only required if there is any pain in malleolar zone and any of these findings. The ottawa ankle rules, developed by stiell, specifies the criteria to be met before ordering xrays for a patient presenting with an acute ankle injury. Rules out clinically significant foot and ankle fractures to reduce use of xray imaging.
The ottawa ankle rule was derived to aid efficient use of radiography in acute ankle and midfoot injuries. The ottawa knee rule was derived to aid in the efficient use of radiography in acute knee injuries. The ottawa ankle rule was derived to aid efficient use of. They state that an xray is required only in patients who have an acute knee injury with one or more of the following.
Awareness and use of the ottawa ankle and knee rules in 5. Awareness and the use of the ottawa ankle and knee rules. Evidencebased management in the emergency department calculated decisions trauma cme the ottawa ankle rule shows the areas of tenderness to be evaluated in ankle trauma patients to determine the need for imaging. The accuracy of the ottawa knee rule to rule out knee fractures. The ottawa knee rules a useful clinical decision tool racgp. The ottawa knee rules the ottawa knee rules okrs were first derived and validated in ottawa, canada, with the aim of reducing the number of unnecessary radiographs ordered after background acute knee injuries are a common presentation in the primary care setting. It has been prospectively validated on multiple occasions in. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. Prospective validation of a decision rule for the use of radiography in acute knee injuries. Diagnostic accuracy and reproducibility of the ottawa knee. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. Comparison of ottawa ankle rules and bernese ankle rules in acute ankle and midfoot injuries injury during daily walking, and the remaining reported other reasons. The ottawa knee rule is a validated clinical decision rule for determining whether knee radiographs should be obtained in the setting of acute knee trauma.
This screening tool was developed because of the need for a rapid and accurate way to avoid unnecessary imaging. Specificities for the ottawa knee rule typically range from 19% to 50%, although the rule is not designed or intended for specific diagnosis. However, the prehospital experience in implementing this clinical decision rule appears poorly described. Epomedicine oct 29, 2017 no comments emergency medicine musculoskeletal system orthopedics radiology. O ottawa rules for xray of knee, ottawa ankle and foot rules lateral view ankle and foot medial view posterior edge or tip of medial malleolus navicular malleolar zone midfoot zone posterior edge or tip of lateral malleolus base of 5th metatarsal 6cm an ankle xray is required only if there is any pain in malleolar zone and any of these findings. The canadian cspine rule the ottawa knee rule the ottawa ankle rules publications. The ottawa knee rules determine the need for radiographs in acute knee injuries. W inability to bear weight 4 steps both immediately and in ed a age greater than or equal to 55 i inability to flex knee to 90 degrees t tenderness isolated to patella or head of fibula posted by dr sajjad pathan at tuesday, april 15, 2014.
The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency. The ottawa rules are a set of clinical decision rules developed by dr. The rules have been demonstrated to decrease unnecessary diagnostic imaging and emergency room wait times which enhances patient comfort and reduces health care costs. Because the clinical significance of avulsion fractures and salterharris type i fractures in children is unclear, we sought to prospectively evaluate the use of the oar in children and to determine whether. Sensitivity and specificity of oar were 100% and 77% respectively.
Expert opinion in the multicentre trial to introduce the ottawa ankle rules for use of radiography in acute ankle injuries stiell et al, 1995a and the guideline for the radiography of the ankle and foot ottawa ankle rules alberta medical association, 2007 is that a person with an ankle or foot injury should be advised to seek medical help. Pdf ottawa ankle rules and subjective surgeon perception. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 3040%. Traumatic knee pain adequacy of clinical information with reference to the ottawa knee rules a negative result on the ottawa knee rules excludes fracture in patients with acute knee injury ottawa ankle rules and the diabetic foot. The ottawa knee rules are useful in ruling out fracture high sensitivity when negative, but poor for ruling in fractures many false positives. The applicability of the ottawa ankle rules in children aged 216 years has been confirmed with 100% sensitivity for significant fractures of the ankle and midfoot. The ottawa knee rules are considered to have a high sensitivity for fracture, while also reducing the overall number of radiographs obtained in an acute setting. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce. The rules are exceptionally simple, relying on just 2 observations. Ian stiell and his research team at the ottawa hospital research institute and the university of ottawa. The ottawa knee rule describes criteria for knee trauma patients who are at low risk for clinically significant fracture and do not warrant knee.
Ottawa ankle rules an overview sciencedirect topics. Radiographic examinations showed 19 fractures out of 100 investigated patients table 1. Pdf the accuracy of the ottawa knee rule to rule out. The objective of this study is to identify evidence of any level describing the use of the oar by. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries.
The ottawa knee rule is a validated clinical decision rule online pdf language converter for determining whether. Use only for injuries ottawa knee rules37 canadian cspine rules ok. A foot xray series is only required if there is any pain the midfoot zone and. The ottawa ankle rules and the buffalo modification of the ottawa rules should be judiciously applied to adult patients with ankle trauma to decrease the total number of ankle radiographs obtained the most important step in ankle fracture management is identifying stable verses unstable fractures. Tenderness of patella is significant only if an isolated finding. Stable fractures will have only one break in the supporting ankle ring. Weightbearing inability was the ottawa ankle rule item that presented the highest reliability, 69.
Rule out a complete tear of the ligaments by doing drawer testing of the ankle before discharging the patient or at the first followup visit ottawa knee rules a knee xray is only required for knee injury patients with any of these findings. Ottawa ankle rules ottawa health research institute. A knee xray series is only required for knee injury patients with any of these findings. Although they were not originally intended for patients younger than age 18 years, a metaanalysis. What are the ottawa ankle rules and how are they used to. Racgp the ottawa knee rules a useful clinical decision. The ottawa ankle rule oar is extensively documented in the emergency department setting and has been subjected to repeated validation. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot. We know more about how well the ottawa ankle rules rule out clinically important fractures of the ankle and midfoot than just about any other diagnostic test. Ottawa knee rule the ottawa hospital research institute. Openurl1crossref2pubmed3web of science4 q in patients with acute knee injuries, is the ottawa knee rule okr accurate for ruling out knee fractures. Bone tenderness at the posterior edge or tip of the lateral malleolus a. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of a knee injury using the ottawa knee rules. Use of the ottawa ankle rule by paramedics in the outof.
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