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Application of Ottawa Ankle Rules

Author Affiliations

  • 1 Department of Orthopaedics, Era Medical College, Lucknow, INDIA
  • 2 Apollo Reach Hospital, Karimnagar, Andhra Pradesh, INDIA
  • 3 RS Nursing home, Fatehabad, Agra, Uttar Pradesh, INDIA

Int. Res. J. Medical Sci., Volume 2, Issue (10), Pages 7-12, October,28 (2014)


Ankle injury is a common injury sustained in an outdoor activity or as a sport injury presenting to the emergency department. Emergency physiciansusually order radiographs for nearly all ankle injury patients, and 85% of these are negative for fracture. So, low cost high volume tests, such as plain radiographs, contribute as much to increasing costs of providing health care as high technology, low-volume procedures. University of Ottawa (Canada) estimated that US $500 million is spent every year on ankle radiographs in North America and suggested that the money spent in negative radiographs can be better utilized elsewhere in health care systems. This prospective study was conducted in the department of Orthopaedics at B.P. Koirala Institute of health Sciences, Nepal in two phases. We validated OAR in100 patients in stphase and in the 2nd phase we implemented the clinical decision rule of Ottawa ankle rule (OAR) in another 100 patients. All individuals coming to this institute with complains of ankle pain secondary to blunt ankle trauma were labeled as suspected case of ankle sprain and included in this study. The cases were examined by the postgraduate junior residents of Orthopaedic department. Exclusion criteria included patients less than 18 years, injury more than 10 days, those who have been referred along with radiographs, those who have ankle/foot wound, multiple trauma patients, pregnant females or comatose /unconscious or uncooperative patients. Statistical analysis showed that in validation phase (phase I) sensitivity is 100%, specificity is 42.5% with Positive predictive value (PPV) of 30.30%, Negative predictive value (NPV) of100% and accuracy of 54%. Similarly, in implementation phase the sensitivity is 100%, specificity is 42.5% with Positive predictive value (PPV) of 31.25%, Negative predictive value (NPV) of 100% and accuracy of 56%. The need for radiographs was reduced in 36% of patient. The average time saved in persons who were not subjected to radiography was about an hour and the money saved by the patient was250 Rs/- per person. We conclude that implementing Ottawa Ankle Rule can identify all clinically relevant fractures of ankle and foot. The need for need for radiography is reduced by 36% saving patients money and time spent in emergency department.


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