Related Experiment Video
Updated: Aug 11, 2026
Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
Validation of the Ottawa Ankle Rules in Iran: a prospective survey
Shahram Yazdani1, Hesam Jahandideh, Hossein Ghofrani
1Education Development Center, Shaheed Beheshti University of Medical Sciences, Evin, Tabnak St, Tehran, Iran. sh_yaz@yahoo.com
Background:
Acute ankle injuries are one of the most common reasons for presenting to emergency departments, but only a small percentage of patients--approximately 15%--have clinically significant fractures. However, these patients are almost always referred for radiography. The Ottawa Ankle Rules (OARs) have been designed to reduce the number of unnecessary radiographs ordered for these patients. The objective of this study was to validate the OARs in the Iranian population.
Methods:
This prospective survey was done among 200 patients with acute ankle injury from January 2004 to April 2004 in the Akhtar Orthopedics Hospital Emergency Department. Main outcome measures of this survey were: sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios (positive and negative) of the OARs.
Results:
Sensitivity of the OARs for detecting 37 ankle fractures (23 in the malleolar zone and 14 in the midfoot zone) was 100% for each of the two zones, and 100% for both zones. Specificity of the OARs for detecting fractures was 40.50% for both zones, 40.50% for the malleolar zone, and 56.00% for the midfoot zone. Implementation of the OARs had the potential for reducing radiographs by 33%.
Conclusion:
OARs are very accurate and highly sensitive tools for detecting ankle fractures. Implementation of these rules would lead to significant reduction in the number of radiographs, costs, radiation exposure and waiting times in emergency departments.
