Abstract
BackgroundThe Ottawa ankle rules (OAR) are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The OAR have been proven that their application reduces unnecessary radiography. They have nearly perfect sensitivity for identifying clinically significant ankle fractures.ObjectivesThe purpose of this study was to assess the applicability of the OAR in China, to examine their accuracy for the diagnosis of fractures in patients with acute ankle sprains, and to assess their clinical utility for the detection of occult fractures.MethodsIn this prospective study, patients with acute ankle injuries were enrolled during a 6-month period. The eligible patients were examined by emergency orthopedic specialists using the OAR, and then underwent ankle radiography. The results of examination using the OAR were compared with the radiographic results to assess the accuracy of the OAR for ankle fractures. Patients with OAR results highly suggestive of fracture, but no evidence of a fracture on radiographs, were advised to undergo 3-dimensional computed tomography (3D-CT).Results183 patients with ankle injuries were enrolled in the study and 63 of these injuries involved fractures. The pooled sensitivity, specificity, positive predictive value and negative predictive value of the OAR for detection of fractures of the ankle were 96.8%, 45.8%, 48.4% and 96.5%, respectively. Our results suggest that clinical application of the OAR could decrease unnecessary radiographs by 31.1%. Of the 21 patients with positive OAR results and negative radiographic findings who underwent 3D-CT examination, five had occult fractures of the lateral malleolus.ConclusionsThe OAR are applicable in the Chinese population, and have high sensitivity and modest specificity for the diagnosis of fractures associated with acute ankle injury. They may detect some occult fractures of the malleoli that are not visible on radiographs.
Highlights
Foot and ankle injuries are common clinical conditions treated by emergency physicians; these injuries account for 6–12% of the patients seen in emergency departments (ED) [1]
Our results suggest that clinical application of the Ottawa ankle rules (OAR) could decrease unnecessary radiographs by 31.1%
The OAR are applicable in the Chinese population, and have high sensitivity and modest specificity for the diagnosis of fractures associated with acute ankle injury
Summary
Foot and ankle injuries are common clinical conditions treated by emergency physicians; these injuries account for 6–12% of the patients seen in emergency departments (ED) [1]. To decrease unnecessary radiation exposure and reduce the waiting time for patients in EDs, Stiell et al developed clinical decision rules (termed the Ottawa ankle rules, OAR) for excluding fractures in acute ankle injuries using only physical examination [3,4,5]. Since their introduction in 1992, the OAR have been widely applied in many countries [6,7,8,9,10,11,12,13], and have been validated as highly sensitive and modestly specific for the detection of ankle fractures in multiple clinical settings [5]. They have nearly perfect sensitivity for identifying clinically significant ankle fractures
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