Ottawa Ankle Rules

Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Derived the Ottawa Ankle and Foot Rules (malleolar/midfoot pain plus bony tenderness at defined sites or inability to bear weight); 100% sensitive for clinically significant fractures.

Stiell IG, McKnight RD, Greenberg GH, et al. Implementation of the Ottawa ankle rules. Prospective multicentre validation and implementation reduced ankle and foot radiography by ~25–30% without missing significant fractures, shortening ED stays.

Widely adopted in emergency-medicine practice for patients ≥ 18 within ~10 days of injury; apply with caution and clinical judgement in intoxication, distracting injuries, sensory deficits, or when the exam is unreliable.