Fracture Screening

Question 1

What are the 4 levels of Canadian C-Spine Rule testing?

Answer 1

1. Inclusion Criteria
   –>
2. High Risk Factors (immediate imaging)
   –>
3. Low Risk Factors (allow ROM testing)
   –>
4. Cervical Rotation

Question 2

If Canadian C-Spine Rule is positive what is preferred imaging?

Answer 2

CT

-If CT in unavailable then x-rays

Question 3

What is the NEXUS criteria for cervical spine imaging?

What are the limitations?

Answer 3

Refer for imaging if ANY are present:
1. Focal NEUROLOGICAL deficit
2. SPINE tenderness
3. ALTERED level of consciousness
4. INTOXICAITON
5. DISTRACTING painful injury

NSAID

Limitations: low specificity and reduced sensitivity in patients ≥65 years

Question 4

What are the Ottawa Knee Rules?

Answer 4

Refer for for radiographs if ANY are present after trauma

1. Age ≥55
2. Tenderness at fibular head
3. Isolated patellar tenderness (no other bony tenderness)
4. Inability to flex knee to 90°
5. Inability to bear weight for 4 steps both immediately after injury AND at presentation

BOTH KNEE/ANKLE RULES HAVE 5 ITEMS

Question 5

What are the Ottawa Foot and Ankle Rules?

Answer 5

Refer for radiographs if ANY are present after trauma

1. Bony tenderness at posterior edge or tip of distal 6 cm of medial malleolus
2. Bony tenderness at posterior edge or tip of distal 6 cm of lateral malleolus
3. Bony tenderness at base of 5th metatarsal
4. Bony tenderness at navicular
5. Inability to bear weight for 4 steps BOTH immediately after injury and at presentation

BOTH KNEE/ANKLE RULES HAVE 5 ITEMS