Purpose: The Ottawa Ankle Rules were developed in order to determine the need for radiographs after acute ankle injury secondary to the risk of fracture.
Rule:
Pain in malleolar or midfoot area and Either:
1. Inability to bear weight immediately after injury AND in the ED (taking 4 steps)
OR
2. Bone tenderness at the posterior edge of tibia or fibula or tip of medial or lateral malleolus
3. Bone tenderness at the navicular or proximal base of 5th metatarsal
| Item | Ankle | Mid foot | Ankle + MidFoot |
| SN | 0.98 | 0.99 | 0.96 |
| SP | 0.40 | 0.38 | 0.26 |
| +LR | 1.67 | ||
| -LR | 0.0-0.1 | ||
SN = sensitivity – ‘SnOut’ helps rule out a disease (higher number is better – >0.9 is excellent)
SP = Specificity – ‘SpIn’ helps rule in a disease (higher number is better – greater than 0.90 is excellent))
+LR = positive likelihood ratio – ratio of positive test results in a patients with the pathology (true positives) higher number is better (> 10 is excellent)
-LR = negative likelihood ratio – ratio of negative test results in a patients with the pathology (false negatives) lower number is better (< 0.1 is excellent)
PPV = positive predictive value – percentage of patients who both test positive & have the disease (true positives)
NPV = negative predictive value – percentage of patients who both test negative & do not have disease (true negatives)
References:
1. Bachmann LM, Kolb E, Koller MT, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. British Medical Journal. 2003; 326(7386): 1-7.
2. Jenkin M, et al. Clinical Usefulness of the Ottawa Ankle Rules for Detecting Fractures of the Ankle and Midfoot. Journal of Athletic Training. 2010; 45(5): 480–482.
3. Leisey, J. Prospective validation of the Ottawa Ankle Rules in deployed military population. Military Medicine. 2004; 169(10):804-6.
4. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992; 21(4): 384–390.
5. Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa ankle rules. JAMA. 1994; 271(11): 827–832.
6. Stiell I, Wells G, Laupacis A, Brison R, Verbeek R, Vandemheen K, Naylor CD. Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group. BMJ. 1995; 311(7005): 594–597.
