Purpose of Ottawa Ankle Rules
The determine if there is a need for radiographs in acute ankle injuries Helps avoid unnecessary imaging
Incidence in ankle sprains between genders
Females have a higher incidence of ankle sprains than males F = 13.6 per 1000 M = 6.94 per 1000 Doherty et al. 2014
Who is more likely to sprain their ankle:
children or adolescents
Children
Doherty et al. 2014
Who is more likely to sprain their ankle:
adolescents or adults
Adolescents
Doherty et al. 2014
Accuracy of Ottawa rules
~100% sensitivity
Modest specificity
When used to exclude fractures of the ankle and mid-foot
Ottawa Rules
Physical Exam and Treatment Tips for Ottawa Rules
Palpate the entire distal 6 cm of tibia and fibula
Closely examine for medial malleolar tenderness
Only use Ottawa rules if patient is over 18 y/o
Encourage follow up for 5-7 days if pain and walking ability don’t improve
Damaged Ligament in an Inversion Ankle Sprain
Calcaneofibular ligament
“Last year we were taught ATF…stupid”
Damaged Ligament in an Eversion Ankle Sprain
Deltoid ligament
Damaged Ligament in a High Ankle Sprain
Syndesmotic tear
Aka the in
Damaged Ligament in a High Ankle Sprain
Syndesmotic tear
aka. interosseus membrane and the fibiofibular ligament
Grade 1 Ankle Sprain
Minimal tenderness and swelling
Minimal Impariment
Pathophysiology - microscopic tearing of collagen fibers
Treatment - Weight bear as tolerated, physical therapy
Grade 2 Ankle Sprain
Moderate tenderness and swelling
Decreased ROM and possible instability
Moderate impairment
Pathophysiology - Complete tear of some but not all collagen fibers in the ligament
Treatment - Immobilize w/ air splint and PT
Grade 3 Ankle Sprain
Significant swelling and tenderness
Instability of joint
Severe impairment
Pathophysiology: Complete tear or rupture of ligament
Treatment: Immobilization, PT, Possible surgical reconstruction
Ottawa Rules for the Knee
Should get an X Ray if any criteria below is met
1) > 55 y/o
2) Isolated tenderness to the patella (no bone tenderness othe than patella)
3) Tenderness of head of fibula
4) Inability to flex to 90º
5) Inability to bear weight both immediately and in ED more than 4 steps
How do you find Cobb angle?
Find the angle created by a parrellel line coming off the superior surface of the most cephalad vertebra in the curve with the parrellel line coming off the inferior surface of the most caudad vertebra in the curve
Classifications of Cobb Angle
Mild = 5-15º
Moderate = 20-45º
Severe = 50º
At what angle is respiratory function comprimised?
Cobb angle > 50º
What does scoliosis do to rib motion?
Adds a torsional motion
