Ottawa Rules

Question 1

What are the Ottawa Ankle Rules?

Answer 1

Screening to determine need for XR in acute ankle injuries

Question 2

Why was Ottawa Rules devleoped?

Answer 2

Rapid and accurate way to avoid unncessary imaging

Question 3

Traditionally, what would a doc do when there was an ankle sprain in the ED?

Answer 3

XR, but less than 15% would be clinically significant and waste money

Question 4

Ottawa ankle rules excludes fractures of what

Answer 4

ankle and midfoot

Question 5

What is senstivity and specifity of Ottawa rules?

Answer 5

• Sensitivity: 100%
• Specificity: modest

Question 6

Inversion fracture of the foot damages ________

Answer 6

calcaneofibular

Question 7

Eversion fracture of the foot damages ________

Answer 7

Deltoid ligament

Question 8

High ankle fracture of the foot causes ________

Answer 8

Syndesmotic tear

Question 9

How do we grade ankle sprains?

Answer 9

Grade 1, 2 and 3

Question 10

Grade 1 ankle sprain

PE:

Impairment:

Path:

Tx:

Answer 10

PE: minimal tenderness and swelling

Impairment: minimal

Path: microscopic tear of collagen fibers

Tx: Weight bear as tolerated, PT

Question 11

Grade 2 ankle sprain

PE:

Impairment:

Path:

Tx:

Answer 11

PE:

• moderate tenderness and swelling
• decreased ROM
• Possible instability

Impairment: moderate

Path: complete tears of SOME collagen fibers in ligament

Tx: immobilize w air splint, PT

Question 12

Grade 3 ankle sprain

PE:

Impairment:

Path:

Tx:

Answer 12

PE: significant swelling and tenderness/instability

Impairment: severe

Path: complete tear of ligament

Tx: immobile, PT, possible surgery

Question 13

What are the Ottawa ankle rules

Answer 13

Perform a XR of ankle if there is pain in the malleolar region with any of the following:

1. Bone tenderness @ posterior edge of the distal 6cm or tip of lateral malleous
2. Bone tenderness @ posterior edge of the distal 6cm or tip of the medial mallelus
3. Cannot bear weight for 4 steps immeditely after injury and when evaluated

Question 14

What are the Ottawa Foot rules

Answer 14

Perform a XR of foot if there is pain in the midfoot region with any of the following:

• 1. Bone tenderness @ naviular bone
• 2. Bone tenderness @ base of the 5th metatarsal
• 3. Cannot bear weight for 4 steps immeditely after injury and when evaluated

Question 15

What important things to consider when using Ottakwa ankle rules?

Answer 15

1. Only use on pts over 18
2. Palpate ENTIRE distal 6cm of tibia + fibia
3. Do not neglect tenderness of medial malleolos

Question 16

What should we do after ottwa rules and pt does not need XR

Answer 16

give written instruction, encourage to follow up in 5-7 days if pain and walking ability hasnot improved

Question 17

Ottawa knee rules (5)

Answer 17

Do a knee XR for knee injury pts if

1. >55YO
2. Isolated tenderness of patella (no other bone is tender)
3. Tenderness of fibular head
4. Cannot flex to 90 degrees
5. Cannot bear weight for 4 steps both immediately after in ED