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Ankle XRayAka: 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. Ankle Syndesmotic Sprain (High Ankle Sprain)
  1. Tibiofibular clear space widening >6 mm
References
1. Labovitz (1998) Foot Ankle Int 19:661
2. Stiel (1994) JAMA 271:827

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.