Evaluating fracture risk in acute ankle sprains: Any news since the Ottawa Ankle Rules? A systematic review

Objective To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray.Methods We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described.Results Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries.Conclusion There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.

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“…It is worth mentioning that there was conversion to surgical treatment for one patient (talus fracture). ( 18 , 19 )…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of injuries due to ankle sprain diagnosed in an orthopedic emergency room

Debieux¹,

Wajnsztejn²,

Mansur³

2019

Einstein (São Paulo)

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“…However, this survey revealed that GPs use such scores only rarely to support their suspected diagnoses. The potential of combining clinical scores and US was pointed out by Jonckheer et al [15] and investigated by Canagasabey et al [16] and Tollefson et al [17], who combined the sensitive but unspecific OFAR with bedside sonography, which thereby increased the specificity of the testing. It would be helpful to formulate such clear diagnostic tools to include US for general practice and other outpatient settings and reduce the number of radiographic examinations, which would avoid unnecessary costs and radiation exposure.…”

Section: Implications For Future Practicementioning

confidence: 99%

Ultrasonography in assessing suspected bone fractures: a cross-sectional survey amongst German general practitioners

et al. 2020

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Background: Over the last two decades, ultrasonography (US) has been shown to be an accurate tool for the diagnosis of suspected bone fractures; however, the integration of this application of US into routine care and outpatient settings needs to be explored. In this study, we surveyed German general practitioners (GPs) to assess their knowledge, attitudes, and utilization of US for the diagnosis of suspected fractures. Methods: Notification of the study, a self-designed questionnaire, and a reminder were mailed to 600 randomly selected GPs in Saxony and Saxony-Anhalt. Results: The response rate was 47.7% (n = 286), and respondents did not differ from the population of all GPs in respect to sex and practice type. Among GPs surveyed, 48.6% used an US device in their practice. On average, GPs diagnosed six patients with suspected fractures per month, yet only 39.3% knew about the possibility of ultrasonographic fracture diagnosis, and only 4.3% of GPs using US applied it for this purpose. Among participants, 71.9% believed that US is inferior to conventional X-rays for the diagnosis of bony injuries. Users of US were better informed of and more commonly used US for fracture diagnosis compared to non-users. Conclusion: The need to rule out possible fractures frequently arises in general practice, and US devices are broadly available. Further efforts are needed to improve the knowledge and attitudes of GPs regarding the accuracy of US for fracture diagnosis. Multicenter controlled trials could explore the safety, usefulness, and effectiveness of this still seldom used diagnostic approach for suspected fractures.

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“…The Ottawa Ankle Rules (OAR) screen for the need for an x-ray following an ankle or foot injury [30]. OAR are evidence based practice decision tool [31] and are included in LALS CPGs [27]. Despite the extensive research and development of OAR and LALS CPGs, complications are common following a LALS [32][33][34][35][36].…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of health professions curricula and management of lateral ankle ligament sprain demonstrates inconsistency

2020

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Background: Health educators aim to graduate students who are safe, effective and practice evidence-based medicine (EBM). Clinical Practice Guidelines (CPGs) are tools for translating evidence into clinical practice for health professionals and educators who lack time to appraise the evidence. There have been CPGs published for lateral ankle ligament sprains (LALS) for physiotherapists, nurses, and doctors. Clinical decision rules have also been developed for LALS to increase the safety of practice. The Ottawa Ankle Rules (OAR) were developed to screen for the need for an x-ray following an ankle or foot injury. Methods: Educators from the Australasian College of Sports and Exercise Physicians (ACSEP), St John Ambulance first aiders, pharmacy, nursing, and physiotherapy disciplines were participants in this study. Using purposeful sampling with semi-structured questions and a LALS case study, 19 Australian educators were interviewed. Curricula and textbooks were also collected and analysed. Two researchers independently analysed the data using a deductive method. Results: Analysis found that no educator used a CPG to inform their teaching. There was no common LALS curriculum for the five groups studied. There were two approaches: a triage curriculum (St John Ambulance, pharmacy, nursing) and a reflective curriculum (ASCEP and physiotherapy). Textbooks influenced curriculum for physiotherapy, pharmacy and first aid educators. The triage curricula recommend rest, ice, compression and elevation (RICE) alone, while the reflective curricula uses OAR, RICE, immobilisation if the LALS is severe, functional support (brace), exercises and manual therapy. In addition, ACSEP and physiotherapy do not recommend electrotherapy. All five groups were cautious about the use of non-steroidal anti-inflammatory drugs (NSAIDs). Conclusions: Physiotherapy and ACSEP educators teach OAR. Despite not using the CPGs to inform curriculum, physiotherapy and ACSEP have unintentionally aligned their curriculum with current LALS CPG recommendations. However, nursing, pharmacy and first aid trainers are not teaching OAR or aligned with LALS CPGs. Educators in pharmacy, nursing and first aid should reexamine their curricula and consider possibly teaching OAR and using CPG. Clinical practice guideline developers should consider pharmacists and first aiders as users of their LALS CPGs.

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Evaluating fracture risk in acute ankle sprains: Any news since the Ottawa Ankle Rules? A systematic review

Cited by 34 publications

References 26 publications

Epidemiology of injuries due to ankle sprain diagnosed in an orthopedic emergency room

Epidemiology of injuries due to ankle sprain diagnosed in an orthopedic emergency room

Ultrasonography in assessing suspected bone fractures: a cross-sectional survey amongst German general practitioners

A qualitative study of health professions curricula and management of lateral ankle ligament sprain demonstrates inconsistency

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