Ankle Fracture: Likelihood Ratios

An ankle series is only indicated for patients who have pain in the malleolar zone and

* Have bone tenderness at the posterior edge or tip of the lateral or medial malleolus

or

* Are unable to bear weight both immediately after the injury and for four steps in the emergency department or doctor's office.

A foot series is only indicated for patients who have pain in the midfoot zone and

* Have bone tenderness at the base of the fifth metatarsal or at the navicular

or

* Are unable to bear weight both immediately after the injury and for four steps in the emergency department or doctor's office.

The following apply to the use of the Ottawa ankle rules:

* If the patient can transfer weight twice to each foot (four steps), he or she is considered able to bear weight even if he or she limps.

* Palpate the distal 6 cm of the posterior edge of the fibula when assessing for bone tenderness.

Study: BMJ 2003 Feb 22;326(7386):417. PMID 12595378