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Ankle XRay

Aka: Ankle XRay, Ottawa ankle rules

Technique
1. Lateral ankle
2. Anteroposterior ankle
3. Ankle Mortis view
  1. Anteroposterior view
  2. Leg internally rotated 15 to 20 degrees
Indications for Ankle XRay: "Ottawa ankle rules"
1. Test Sensitivity for Malleolar Fracture: 95%
2. Requires alert adult
3. Injury within prior 10 days
4. Ankle XRay not needed if both are true:
  1. Able to ambulate at injury or in ER for 4 steps
  2. No pain over distal posterior 6 cm of tibia, fibula
5. Foot Xray not needed for mid-Foot Pain if both true:
  1. No pain at fifth Metatarsal base and Tarsal Navicular
  2. Able to ambulate at injury or in ER for 4 steps
Pitfalls
1. Growth Plate Fracture in adolescent
  1. May be missed on Ankle XRay
  2. Consider if pain over lateral malleolus (fibula)
2. AnkleSyndesmotic Sprain (High Ankle Sprain)
  1. Tibiofibular clear space widening >6 mm
References
1. Labovitz (1998) Foot Ankle Int 19:661-7
2. Stiel (1994) JAMA 271:827-32

Family Practice Notebook

Patients should address specific medical concerns with their physicians.

Although access to this page is not restricted, the information found here is intended for use by medical providers.

This page was written by Scott Moses, MD, last revised on 10/21/2007 and last published on 5/17/2012.

This is one of 5740 pages in the Family Practice Notebook