Diagnostic Accuracy of the Ottawa Ankle Rules to Exclude Fractures in Acute Ankle Injuries in Adults

Diagnostic Accuracy of the Ottawa Ankle Rules to Exclude Fractures in Acute Ankle Injuries in Adults

Ankle trauma is a common reason for individuals to visit the emergency department or a family physician, chiropractor or physiotherapist. Currently, radiographic assessment is routinely used in ankle trauma, despite evidence suggesting that it is not always required. The Ottawa Ankle Rules (OAR) constitute a clinical decision tool that was created with the intent of ruling out ankle fractures to reduce unnecessary use of radiographs for patients with an acute ankle injury.

The Ottawa Ankle Rules are:

1. Pain or bone tenderness in the posterior distal tibia or tip of the medial malleolus
2. Pain or bone tenderness in the posterior distal fibula or tip of the lateral malleolus
3. Unable to weight bear immediately after the injury or for four steps in the emergency department

A systematic review assessing the OAR has demonstrated it has a sensitivity of 97.3% and a specificity of 36.6% in the adult population. However, despite the high accuracy to rule out an ankle fracture, clinical behavior to send for radiographs has not significantly changed due to (among other things, perhaps): the immediate access of radiography, fear of litigation, and a lack of dissemination of this rule in primary care.

The primary objective of this study is to conduct a review of the literature to determine whether the Ottawa ankle rules accurately rule out ankle fractures and if it can reduce the need for x-rays in acute ankle injuries. This is the first systematic review to exclude the pediatric population, only assessing the accuracy of this rule in adults suffering an acute ankle injury.

RESEARCH REVIEW: “Diagnostic Accuracy of the Ottawa Ankle Rules to Exclude Fractures in Acute Ankle Injuries in Adults”

This paper was published in BMC Musculoskeletal Disorders (2022) and this Review is posted in Ankle-Foot, Diagnostic Imaging and the 2023 Archive.