Rapid Review: Ottawa Ankle Rules

Rapid review
Ottawa ankle rules

Ottawa Foot and Ankle Rules

  • X-rays required if
    • Patient cannot bear weight for 4 steps
    • Distal 6 cm tibia/fibula tenderness
    • Medial/lateral malleolus tenderness
    • 5th metatarsal tenderness
    • Navicular tenderness

Sample question:

A 16-year-old boy presents complaining of right ankle pain after injuring himself while playing basketball. He states that he “twisted his ankle” when he landed on another players foot trying to get a rebound. He has not been able to walk on his right foot since this occurred two hours ago and cannot do so in the ED. On examination, his pulses are intact. Strength and sensation are normal. The ankle is swollen laterally. He is tender over the lateral malleolus and at the base of the fifth metatarsal. No tenderness or swelling is noted over the proximal tibia and fibula. Which of the following is true regarding emergency department radiographic workup of this patient?


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