Acute ankle injuries: clinical/radiologic assessment in diagnosis

Acute ankle injuries represent a large burden of illness in the primary care/emergency setting. Concern has been expressed in the medical literature about the unnecessary use of X-rays in the assessment of these patients. A literature review was conducted to address the question: "Can clinical examination alone accurately diagnose fractures and sprains in patients with acute ankle injuries?" Published reports offer inconsistent conclusions on the value of clinical criteria in the diagnosis of fractures or sprains. These inconsistent conclusions appear to result from numerous biases, different patient populations studied, varied interpretations of normal and abnormal results, and different groups of examiners. The only criteria associated with the diagnosis of fracture in more than one study are age greater than 40 years, inability to bear weight on examination, "point" or "bone" tenderness, and swelling. Until consistent results are available, no change in the rate of X-ray referral should be expected.