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A 20-year perspective on the Ottawa Ankle Rules: Are we still on solid footing?
1Lawrence Herman is president of Palantir Healthcare, LLC, in Boiling Springs, S.C., an adjunct faculty member in the Doctoral of Medical Science program, part of the School of PA Medicine at the University of Lynchburg in Lynchburg, Va., and a speaker for NOVO Nordisk in the area of obesity treatment. The author has disclosed no other potential conflicts of interest, financial or otherwise.
The Ottawa Ankle Rules help reduce unnecessary ankle X-rays for injuries. This review assesses their continued validity and effectiveness after over 20 years of use in emergency departments.
Area of Science:
- Emergency Medicine
- Orthopedic Surgery
- Radiology
Background:
- The Ottawa Ankle Rules (OAR) were established in 1995 as a guideline for ordering radiographs in patients with ankle and foot injuries.
- These rules aim to reduce unnecessary imaging by identifying fractures unlikely to require intervention.
Purpose of the Study:
- To evaluate the continued validity and clinical utility of the Ottawa Ankle Rules after more than two decades of implementation.
- To determine if the OAR should remain the standard of care or be superseded by alternative protocols.
Main Methods:
- Review of existing literature and clinical studies on the Ottawa Ankle Rules.
- Analysis of the OAR's performance in reducing radiographic utilization in emergency departments.
- Assessment of diagnostic accuracy and impact on patient management.
Main Results:
- The Ottawa Ankle Rules have demonstrated significant success in decreasing the number of ankle and foot radiographs ordered.
- Studies indicate the OAR maintain a high degree of accuracy in identifying significant fractures requiring further treatment.
- Despite their age, the rules continue to be a reliable tool for clinical decision-making in acute ankle and foot injuries.
Conclusions:
- The Ottawa Ankle Rules remain a valid and effective clinical decision tool for managing ankle and foot injuries.
- Continued use of the OAR is recommended to optimize resource allocation and reduce patient exposure to radiation.
- Further research may explore refinements or complementary protocols to enhance the OAR's utility.
