Abstract
Introduction: Ankle and midfoot injuries are one of the most common orthopaedic complaints, both in the general medicine and the orthopedic practice. The percentage of fractures among these is small, however many of them will undergo an x-ray. Ottawa ankle rules are clinical guidelines developed for the use of radiography in these cases. This aim of this prospective study was to examine these rules’ implementation in the Israeli emergency medicine department and our ability both to predict a fracture and to reduce the amount of unnecessary x-rays.
Materials and Methods: Ninty-two consecutive patients with ankle injuries attending our emergency medicine department were divided in two groups. Study group included 32 patients who arrived during the morning shift and were examined by an internal medicine specialist according to the Ottawa ankle rules. Patients discharged without an x-ray were followed in the clinic or by telephone communication. Control group included 60 patients who were examined during the evening and night shifts by orthopedic residents unaware of the study.
The mean age in the study group was 24 years and in the control group – 26 years. There was good acceptance of the study in patients of the study group. Only 2 of them insisted on the xrays and were excluded from the study. Rest 30 patients were followed as described.
Results: Nine patients (30%) in the study group underwent an x-ray as opposed to 55 patients (92%) in the control group (p< 0.001). There was one fracture diagnosed in each group. In the study group, no fractures were found later in patients discharged without an x-ray. The mean time spent in the emergency department was 58 minutes in the study group and 98 minutes in the control group (p< 0.002).
Discussion: The Ottawa ankle rules were developed as a simple “yes/no” decision tool as to whether to x-ray the ankle. In our emergency department, these rules were proved both accurate and safe. They can be effectively used by professionals not trained in trauma. It can save radiation and patient waiting time without jeopardizing the treatment.
The abstracts were prepared by Orah Naor, IOA Co-ordinator and Secretary. Correspondence should be addressed to Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
