Shetty Test Challenges Ottawa Ankle Rules in Detecting Foot and Ankle Fractures: A Prospective Comparative Study

Area of Science:

• Orthopedics
• Emergency Medicine
• Diagnostic Imaging

Background:

• Ankle joint injuries are common, leading to high healthcare costs.
• Ottawa Ankle Rules (OARs) aim to reduce unnecessary X-rays but their accuracy is debated.
• The Shetty Test (ST) is a new diagnostic tool for ankle and foot fractures.

Purpose of the Study:

• To compare the diagnostic accuracy of the Shetty Test (ST) against the Ottawa Ankle Rules (OARs).
• To evaluate the effectiveness of these diagnostic tools in detecting ankle and foot fractures.

Main Methods:

• A prospective comparative study included 112 adult patients with ankle or foot injuries.
• Data were collected over six months in a University Hospital's Emergency Department.
• Diagnostic accuracy metrics (sensitivity, specificity, PPV, NPV) were calculated for both ST and OARs.

Main Results:

• The ST demonstrated a sensitivity of 68.4% and specificity of 76.3%.
• The OARs showed higher sensitivity (94.7%) but lower specificity (15%).
• Combined use of ST and OARs resulted in 100% sensitivity and NPV.

Conclusions:

• The Shetty Test is reliable but did not outperform OARs individually.
• Conjunctive use of ST and OARs significantly improves diagnostic accuracy for ankle and foot fractures.
• The ST's simplicity makes it a potentially valuable tool for emergency department personnel.