Thursday, December 1, 2011

Canada? Canada!

A 40 year old man comes in with a soccer injury. He twisted his ankle in a game and has ankle pain. On exam, he can bear weight but limps. There is tenderness at the distal 6cm of the posterior edge of the fibula.

Challenge: Do you take ankle X-rays and why?

Image is in the public domain, from Wikipedia.

4 comments:

Anonymous said...

Yes- Ottawa Ankle rules:

Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus.

Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus.

Inability to bear weight for 4 steps both immediately and in the emergency department.

Brady said...

Yes you do. Ottawa ankle rules are pretty clear cut:

X-rays are only required if there is any pain in the malleolar zone and any one of the following:

- Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
- Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR
- An inability to bear weight both immediately and in the emergency department for four steps.

FIRECRACKER said...

No X-rays according to the Ottawa Rules for ankle injury. Patient can bear weight and doesn't have pain in the malleolar zone.

Craig Chen said...

yes, this case is the Ottawa ankle rules - which I had to apply to a friend with an injury last week.
-
Canada? Canada!

The Ottawa ankle rules are highly sensitive for excluding ankle fracture. X-rays are only indicated if the pain is in the malleolar zone and there is tenderness along the posterior edge or tip of the medial or lateral malleolus, or if the patient is unable to bear weight. Here, the distal 6cm of the fibular represents the posterior edge of the malleolus, and so X-rays are appropriate.

Source: UpToDate.