Radiography in acute ankle injuries: The Ottawa Ankle Rules versus local diagnostic decision rules

Pijnenburg, A. C. M.; Glas, Afina S.; Roos, Marnix A.J. de; Bogaard, Kjell; Lijmer, Jeroen G.; Bossuyt, Patrick M.; Butzelaar, Rudolf M J M; Keeman, J. N.

doi:10.1067/mem.2002.121397

Cited by 33 publications

(19 citation statements)

References 18 publications

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“…[12][13][14]20] The final selection contains one systematic review and 21 primary studies. [1,[15][16][17][18][19][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] A description of these studies is available in Tables 2 and 3. The paucity of data and their heterogeneity prevented us from conducting a meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies were identified in recent literature on this topic (Table 5). [23,24,26,31,35] An additional vibrating tuning fork test in patients with positive OAR test may lead to a marked reduction in ankle radiographs. The specificity reached 95% if the tuning fork is applied on the distal fibula shaft compared to 61% on the tip of the lateral malleolus without any reduction in the sensitivity (both 100%).…”

Section: Ottawa Ankle Rulesmentioning

confidence: 99%

“…[24] The Leiden and the Utrecht ankle rules (Box 1b) appear to have higher specificities and lower sensitivities than the OAR. [26,31,35] …”

Section: Ottawa Ankle Rulesmentioning

confidence: 99%

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

Jonckheer

Willems

Ridder

et al. 2015

European Journal of General Practice

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The Ottawa ankle rules remain of utmost importance in identifying X-ray eligible patients with acute ankle sprains. The role of the Bernese ankle rules instead of the OAR and the added-value of the tuning fork test and ultrasound in patients with positive OAR are promising but should be confirmed. ABSTRACTBackground Ankle sprain is frequently encountered, both in primary care and in emergency departments. Since 1992, the Ottawa ankle rules (OAR) can assist clinicians in determining whether an X-ray should be performed to exclude a fracture. Several guidelines recommend the use of OAR based on a systematic review from 2003. Ten years later, one can wonder if this recommendation should be changed. Objective To review systematically the current evidence on the most accurate method to assess the fracture risk after an ankle sprain in adults. Methods A methodical search for systematic reviews, meta-analyses and primary studies was carried out in Medline, Cochrane Database of systematic reviews, Embase, Pedro, CINAHL, Medion and specific guideline search engines. At least two independent researchers performed selection, quality appraisal (with validated checklists) and data extraction. Results One systematic review and 21 primary studies were selected. Sensitivity and specificity of the OAR range from 92-100% and from 16-51%, respectively. To improve the OAR specificity, other tools are proposed such as the Bernese ankle rules. Vibrating tuning fork test and ultrasound could be useful in patient with OAR positive to decrease the need for radiographs. No evidence was found in favour of the use of magnetic resonance imaging (MRI) or computed tomography (CT) in the acute phase of ankle sprain. Conclusion The findings confirm the value of the OAR at ruling out fractures after an ankle sprain and propose other or additional tools to decrease the need for X-rays.

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Section: Resultsmentioning

confidence: 99%

Section: Ottawa Ankle Rulesmentioning

confidence: 99%

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

Jonckheer

Willems

Ridder

et al. 2015

European Journal of General Practice

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“…So kann z. B. bei der Distorsion des oberen Sprunggelenks, welche mit 5% eine der häufigs-ten Verletzungen in der chirurgischen Notaufnahme darstellt [15], die Ruptur des medialen [6] und lateralen Kollateralbandapparats [11,13] …”

Section: Sonografieunclassified

Akutdiagnostik von Sportverletzungen

Drews

2016

OP-JOURNAL

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Zusammenfassung Zur Einleitung einer effektiven und zeitnahen Therapie nach Sportverletzungen ist ebenfalls eine zeitnahe effektive Diagnostik erforderlich. Aus der Anamnese und klinischen Untersuchung leiten sich Dringlichkeit und Reihenfolge der weiteren apparativen Diagnostik ab. Die Sonografie stellt hier aufgrund der vornehmlich weichteiligen Verletzungen den Grundstein dar. Hiermit k?nnen bereits viele Diagnosen gestellt oder ausgeschlossen werden. F?r eine weiterf?hrende Kernspintomografie ist anhand der klinisch gestellten Verdachtsdiagnose der Zeitrahmen zu setzen. W?hrend einige Diagnosen mit Verz?gerung bildmorphologisch gesichert werden k?nnen, brauchen andere eine unmittelbare MRT zur Einleitung der weiteren Therapie und Erreichung eines optimalen Outcomes.

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“…However, although only a few of these patients (approximately 15%) have a significant clinical fracture, radiography is performed on almost all patients without leading to a positive diagnostic result in 85% of cases [1][2][3][4][5]. By developing the Ottawa ankle rules (OARs) [3,6], Stiell and colleagues attempted to help physicians rapidly recognize OARs have been validated in several different countries [10][11][12][13][14][15][16][17][18][19][20]. In their systematic review, Bachman and coworkers [20] found that the sensitivity of the OARs range from 96.4% to 99.6%, while the specificity ranges from 26.3% to 47.9%.…”

Section: Introductionmentioning

confidence: 99%