Ottawa Rules

These are a set of rules to determine if a patient requires imaging to assess for potential fracture. If none of the criterion are met a patient does not usually require an x-ray.

There are three sets of rules, one each for the foot, ankle and knee.

While all of these rules can be used in patients under the age of 18, they should be used with caution.

Ottawa Foot Rules

Imaging is required if there is pain in the mid-foot zone and any of the following:

  • Tenderness to palpation along the 5th metatarsal
  • Tenderness to palpation along the navicular bone
  • An inability to weight bear for four steps

Ottawa Ankle Rules

Imaging is required is there is pain the malleolar zone and any of the following:

  • Tenderness to palpation of the lateral malleolus or the posterior, distal 6cm of the fibula
  • Tenderness to palpation of the medial malleolus or the posterior, distal 6cm of the tibia
  • An inability to weight bear for four steps

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Knee Rules

Imaging is required if the patient has an acute knee injury and any of the following:

  • Age >55 years
  • Inability to flex the knee to 90 degrees (does not have to go past 90)
  • Tenderness to palpation of the patella
  • Tenderness to palpation of the head of the fibula
  • An inability to weight bear for four steps

ottawa-knee

How good are these rules?

Near 100% sensitivity for detecting fractures of the ankle or mid-foot.

98-100% sensitivity for detecting fractures of the knee.

References:

http://www.bmj.com/content/326/7386/417

http://www.ohri.ca/emerg/cdr/docs/cdr_ankle_card.pdf

http://www.emottawa.ca/assets/documents/research/cdr_knee_card.pdf

http://www.mdcalc.com/ottawa-ankle-rule/

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One Comment Add yours

  1. Tatsu Kuwasaki says:

    Nice one Kibby. Thanks for the input!

    Like

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