Article

Clinical Usefulness of the Ottawa Ankle Rules for Detecting Fractures of the Ankle and Midfoot

Biokinetics Research Laboratory, Department of Kinesiology, Temple University, Philadelphia, PA 19122, USA.
Journal of athletic training (Impact Factor: 2.02). 09/2010; 45(5):480-2. DOI: 10.4085/1062-6050-45.5.480
Source: PubMed
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    • "Several studies validated the Ottawa ankle rules as an effective tool to safety decrease the number of radiographic exams in foot and/or ankle injuries to 28-40%.[567891011121314151617] "
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    ABSTRACT: Background:Foot and ankle injuries are frequent in emergency departments. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns are almost always simple, lack of fracture diagnosis can lead to poor functional outcomes.Aim:The present study aims to evaluate the reliability of the Ottawa ankle rules and the orthopedic surgeon subjective perception to assess foot and ankle fractures after sprains.Subjects and Methods:A cross-sectional study was conducted from July 2012 to December 2012. Ethical approval was granted. Two hundred seventy-four adult patients admitted to the emergency department with foot and/or ankle sprain were evaluated by an orthopedic surgeon who completed a questionnaire prior to radiographic assessment. The Ottawa ankle rules and subjective perception of foot and/or ankle fractures were evaluated on the questionnaire.Results:Thirteen percent (36/274) patients presented fracture. Orthopedic surgeon subjective analysis showed 55.6% sensitivity, 90.1% specificity, 46.5% positive predictive value and 92.9% negative predictive value. The general orthopedic surgeon opinion accuracy was 85.4%. The Ottawa ankle rules presented 97.2% sensitivity, 7.8% specificity, 13.9% positive predictive value, 95% negative predictive value and 19.9% accuracy respectively. Weight-bearing inability was the Ottawa ankle rule item that presented the highest reliability, 69.4% sensitivity, 61.6% specificity, 63.1% accuracy, 21.9% positive predictive value and 93% negative predictive value respectively.Conclusion:The Ottawa ankle rules showed high reliability for deciding when to take radiographs in foot and/or ankle sprains. Weight-bearing inability was the most important isolated item to predict fracture presence. Orthopedic surgeon subjective analysis to predict fracture possibility showed a high specificity rate, representing a confident method to exclude unnecessary radiographic exams.
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    ABSTRACT: Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.
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    ABSTRACT: Many older adults are working beyond what was considered a "normal" retirement age in past generations. If work-related injury occurs, older adults may have increased vulnerabilities due to age and comorbid conditions not shared by their younger working peers. This article presents an individual example in which these vulnerabilities are explored, and unique processes within the work environment are noted. Awareness of the risks to older workers will aid clinicians in any setting to maximize prevention and management of co-morbidities that improve health status, function, and employment performance for older workers.
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