Ottawa Knee, Ankle, and Foot Rules
Plain film xrays are indicated if patients have any of the following findings:
| OTTAWA KNEE RULES |
Patient age ≥ 55 years
|
| Isolated tenderness of the patella |
| Tenderness at the head of the fibula |
| Inability to flex knee to 90 degrees |
| Inability to walk 4 steps both immediately and in the ED |
| OTTAWA KNEE DECISION RULES |
| Sensitivity 100% |
| Reduced xray need by 49% |
Reference: Validation of the Ottawa Knee Rules (Emparanza, Aginaga, Reglas de Ottawa)
Image taken from http://www.mdcalc.com/ottawa-ankle-rules
| OTTAWA ANKLE RULES |
Most distal 6 cm of fibula (LM): Tenderness at or along posterior edge
|
| Most distal 6 cm of tibia (MM): Tenderness at or along posterior edge |
| Inability to walk 4 steps both immediately and in the ED |
| OTTAWA FOOT RULES |
| Tenderness at base of 5th metatarsal |
| Tenderness over navicular bone |
| Inability to walk 4 steps both immediately and in the ED |
| OTTAWA FOOT AND ANKLE DECISION RULES |
| Sensitivity 97.8% |
| Specificity 31.5% |
| Negative LR = 0.07 |
Reference: The injured ankle and foot (Dan Mayer)
Pediatric Pearls
- Ankle and Foot Rules: variable validation data for pediatric patients
- Knee Rules: OK to use for pediatrics patients. See Validation of the Ottawa Knee Rule in Children
- If a pediatric patient, who still has an unfused growth plate at the lateral malleolus, sustains an ankle inversion injury, the patient does NOT have an anterior talofibular ligament (ATFL) ankle sprain. Instead, the patient has a Salter-Harris I fracture. Ligaments are stronger than growth plates.
