HFHT's Practising Wisely Newsletter
For clinicians, by clinicians.
Issue 14: Ankle Problems Continued - When Does an X-Ray Make Sense?
February 28, 2017

It is winter and there are many people slipping and falling on ice and sustaining what looks like more than just an “ankle sprain”. Who needs an x-ray?

The Ottawa Ankle Rules have been around for some time, helping clinicians to decide on the necessity of doing an x-ray in the setting of ankle injury. The Rules are as follows:

"An ankle x-ray is only required if there is any pain in the malleolar zone and any one of the following:

  • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus,


  • Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus,


  • An inability to bear weight both immediately and in the emergency department for four steps."  

It is useful to show our patients the criteria for doing an x-ray as part of their assessment. The HFHT Intranet has a custom form called Ottawa Ankle Assessment for Telus PSS EMR which is useful for doing this and in documenting the encounter. Visit the Quick Links section of this email to access the custom form.

It is of interest that Ottawa Rules also exist for knees and spine - we've included these resources in our Quick Links too, and will share more about them in future newsletters!

Don't forget to tune in to the monthly Choosing Wisely Talks! On March 2, Dr. Shawn Dowling and Ms. Heather Hair will be focusing on advancing patient engagement through information design.Visit our Quick Links section to be connected to more information.

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