Ottawa ankle rules

Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review

BMJ 2003;326:417 ( 22 February )

x-rays are only required if there is any pain in the malleolar or midfoot area, and any one of the following:

• Bone tenderness along the distal 6cm of the posterior edge of the tibia or tip of the medial malleolus
• Bone tenderness along the distal 6cm of the posterior edge of the fibula or tip of the lateral malleolus
• Bone tenderness at the base of the fifth metatarsal (for foot injuries).
• Bone tenderness at the navicular bone (for foot injuries).
• An inability to bear weight both immediately and in the emergency department for four steps.

Certain groups are excluded, in particular children (under the age of 18), the pregnant, and those with diminished ability to follow the test (for example due to head injury or intoxication).