Keywords:
Emergency, Musculoskeletal bone, Plain radiographic studies, Audit and standards, Decision analysis, Patterns of Care
Authors:
C.-T. Cheng, D. Varma, D. Smit; VIC/AU
DOI:
10.1594/ranzcr2016/R-0011
Purpose
The Ottawa Anke Rules (OAR) were developed as a clinical decision making tool that maximises sensitivity to rule out ankle or midfoot fractures [1],
and has the potential to substantially reduce unnecessary radiographic examinations.
The OAR are a clinical decision making tool that maximizes sensitivity to rule out ankle or midfoot fractures.
The ankle assessment covers the ability to walk four steps (immediately after the injury and in the ED) and notes localised tenderness of the posterior edge or tip of either malleolus (four spots).
The mid-foot assessment covers the ability to walk and notes localised tenderness of the navicular or the base of the fifth metatarsal. If the patient has positive findings of any of the above,
they should then go on to have an x-ray [1].
This study focuses specifically on the assessment of the ankle only.
Despite its proven efficacy,
there is suggestion that impact on behaviour in clinical practice may be small [2,3].
The objectives of this study were as follows:
- Assess the current usage of the OAR in ruling out ankle fractures in two major metropolitan emergency departments in Australia
- Evaluate the current concordance rate of scoring with positive findings on radiography
- Assess the usage of additional modalities of imaging