Diagnostic accuracy of the Ottawa ankle rule to exclude fractures in acute ankle injuries in adults: a systematic review and meta-analysis

Review written by Dr Chris Bleakley info

Key Points

  1. The Ottawa Ankle Rules (OAR) can help clinicians determine the likelihood of a bony ankle injury after trauma.
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BACKGROUND & OBJECTIVE

Patients with acute ankle trauma commonly present to Emergency Departments (EDs). One of the first diagnostic decisions facing the practitioner is differentiating between bony and soft tissue injuries of the ankle. The Ottawa Ankle Rules (OAR) were developed back in the early 1990’s to help identify ankle injuries with high suspicion of bony injury, requiring radiological assessment.

The OAR can be quickly applied in any clinical setting, with patients referred for ankle X-Ray if they meet any ONE of the following criteria: pain or bone tenderness in the posterior distal tibia, or tip of medial malleolus, or posterior distal fibula, or tip of the lateral malleolus; AND/OR are unable to weight bear immediately after the injury, or in the ED.

The overarching aim of the OAR is to streamline assessment of acute ankle injuries, preventing unnecessary exposure to ionising radiation. This extensive review aimed to investigate the diagnostic accuracy of the OAR for diagnosing ankle fractures in an adult population.

The Ottawa Ankle Rules were developed to help identify ankle injuries with high suspicion of bony injury, requiring radiological assessment.
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A patient presenting with ankle trauma, whose Ottawa ankle rules is negative, has a very low chance of having a fracture and usually doesn’t require x-ray.

METHODS

  • This was a systematic review and meta-analysis that followed the PRISMA-P template.
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