Foot /Ankle fracture assessment with certainty
The above picture is from the website: www.epainassist.com
How does one know if they fractured their ankle or foot? Was it just a sprain of the ligaments? Do I need to see a Doctor at the Emergency Room? Do I need to have an Xray? These are important questions. Here are some possible answers from current research from the website medcalc.com
(If a patient feels they need to go the ER they should and follow the direction of their physician.)
The critical things to remember are if it meets these 2 criteria it probably is fractured
- If it is quite tender on the ankle bone region of the medial or lateral malleolus (the inside or outside bone protuberances) , at the navicular region (see below) , at the base of the 5th metatarsal region (see below)
- If you can’t walk on it right away and in the emergency room
The Ottawa ankle rule were derived to aid in the efficient use of radiography in acute ankle and midfoot injuries.
- Rules have been prospectively validated on multiple occasions in different populations and in both children and adults.
- Sensitivities ( Remember that for sensitivity of a test if is negative you can more likely rule it out) for the Ottawa ankle rule range from the high 90%-100% range for “clinically significant” ankle and midfoot fractures. This is defined as a fracture or an avulsion (separation of ligament from bone) greater than 3 mm.
- Specificities ( Remember specificity means if the test is positive you can more likely rule it in) for the Ottawa ankle rule are approximately 41% for the ankle and 79% for the foot, though the rule is not designed/intended for specific diagnosis.
- The Ottawa ankle rule are useful in ruling out fracture (high sensitivity), but poor for ruling in fractures (many false positives).
Tips from the creators at University of Ottawa:
- Palpate the entire distal 6cm of the fibula and tibia;
- Do not neglect the importance of medial malleolar (bulging bone on inside of ankle) tenderness;
- “Bearing weight” counts even if the patient limps;
- Be caution in patients under age 18.
Precautions from the creators at University of Ottawa:
- Clinical judgment should prevail if examination is unreliable:
- Uncooperative patient
- Distracting painful injuries
- Diminished sensation in legs
- Gross swelling which prevents palpation of malleolar tenderness
- Always provide written instructions
- Encourage follow-up in 5-7 days if pain and ability to walk is not better
- All information above from the site below
- Calvin Hwang MD author/contributor