Modified Ottawa ankle rules as a decision aid for upper extremity injury: Report of two cases

Abstract

Summary Objective The published guidelines for radiographic examination of lower extremity injuries are known as the ‘Ottawa rules’. These rules, initially published in 1992, were established to decrease the amount of unnecessary radiographs. False negatives when following the Ottawa rules are low and have reduced the number of unnecessary x-rays. In clinical settings, the rules and their associated algorithms are important as an aid for determining course of care. This paper documents two cases where adaptation of the Ottawa rules suggested the need for upper extremity radiography. Subsequent x-rays revealed the presence of a fracture in both cases. Clinical features The first case was an 8-year-old girl who was struck on the arm while playing. She experienced pain but refused to let anyone examine her arm. The second case was a 24-year-old male who fell 5 days earlier and landed on his right hand. The application of the adapted Ottawa rules suggested the potential for fracture, which was subsequently confirmed by radiographs. Intervention and outcome Radiographs confirmed the fracture and both patients were referred for orthopedic consultation and treatment. Conclusion These two cases, where the clinical decision making for a wrist injury was guided by an adaptation of the Ottawa ankle rules, highlight the lack of guidelines for upper extremity x-rays following injury and suggest that the Ottawa rules could form the basis for such guidelines. Further studies are required to demonstrate their reliability and validity for everyday clinical use.