User login
STANFORD, CALIF. — The Ottawa Ankle Rules for children and adolescents can take some of the guesswork out of evaluating ankle injuries and cut down on the number of needless x-rays of sprains.
“Is it broken? Is it not broken? In the emergency department, it's the bane of our existence,” said Dr. Bernard W. Dannenberg, director of pediatric emergency medicine at the Stanford (Calif.) University Medical Center.
Simplicity is key to the rules, first developed for adults and later validated for children at the University of Ottawa and the University of Manitoba in Winnipeg (Acad. Emer. Med. 1999;6:1005–9).
The rules follow several criteria, simply stated:
▸ Has the child been able to walk four steps or more on the injured ankle, either at the time of the injury or any time since?
▸ Is there an absence of significant pain when the physician presses with a thumb on the posterior edge or tip of the lateral or medial malleolar zones?
▸ Is there an absence of significant tenderness at the base of the fifth metatarsal or navicular bone (in the case of suspicion of a fracture in the mid-foot)?
If the answers to these questions are affirmative, the injury can safely be bandaged with an Ace wrap for comfort and the patient instructed to use crutches without obtaining an x-ray, Dr. Dannenberg said at a pediatric update sponsored by Stanford University.
The rules have been found to be 100% sensitive for a fracture of the ankle or mid-foot in children aged 2–16 years, and 24% and 36% specific for fractures of the ankle and mid-foot, respectively. Following the rules has the potential of reducing the number of ankle and mid-foot x-ray series by 16%–29%, according to the authors of the pediatric validation study.
STANFORD, CALIF. — The Ottawa Ankle Rules for children and adolescents can take some of the guesswork out of evaluating ankle injuries and cut down on the number of needless x-rays of sprains.
“Is it broken? Is it not broken? In the emergency department, it's the bane of our existence,” said Dr. Bernard W. Dannenberg, director of pediatric emergency medicine at the Stanford (Calif.) University Medical Center.
Simplicity is key to the rules, first developed for adults and later validated for children at the University of Ottawa and the University of Manitoba in Winnipeg (Acad. Emer. Med. 1999;6:1005–9).
The rules follow several criteria, simply stated:
▸ Has the child been able to walk four steps or more on the injured ankle, either at the time of the injury or any time since?
▸ Is there an absence of significant pain when the physician presses with a thumb on the posterior edge or tip of the lateral or medial malleolar zones?
▸ Is there an absence of significant tenderness at the base of the fifth metatarsal or navicular bone (in the case of suspicion of a fracture in the mid-foot)?
If the answers to these questions are affirmative, the injury can safely be bandaged with an Ace wrap for comfort and the patient instructed to use crutches without obtaining an x-ray, Dr. Dannenberg said at a pediatric update sponsored by Stanford University.
The rules have been found to be 100% sensitive for a fracture of the ankle or mid-foot in children aged 2–16 years, and 24% and 36% specific for fractures of the ankle and mid-foot, respectively. Following the rules has the potential of reducing the number of ankle and mid-foot x-ray series by 16%–29%, according to the authors of the pediatric validation study.
STANFORD, CALIF. — The Ottawa Ankle Rules for children and adolescents can take some of the guesswork out of evaluating ankle injuries and cut down on the number of needless x-rays of sprains.
“Is it broken? Is it not broken? In the emergency department, it's the bane of our existence,” said Dr. Bernard W. Dannenberg, director of pediatric emergency medicine at the Stanford (Calif.) University Medical Center.
Simplicity is key to the rules, first developed for adults and later validated for children at the University of Ottawa and the University of Manitoba in Winnipeg (Acad. Emer. Med. 1999;6:1005–9).
The rules follow several criteria, simply stated:
▸ Has the child been able to walk four steps or more on the injured ankle, either at the time of the injury or any time since?
▸ Is there an absence of significant pain when the physician presses with a thumb on the posterior edge or tip of the lateral or medial malleolar zones?
▸ Is there an absence of significant tenderness at the base of the fifth metatarsal or navicular bone (in the case of suspicion of a fracture in the mid-foot)?
If the answers to these questions are affirmative, the injury can safely be bandaged with an Ace wrap for comfort and the patient instructed to use crutches without obtaining an x-ray, Dr. Dannenberg said at a pediatric update sponsored by Stanford University.
The rules have been found to be 100% sensitive for a fracture of the ankle or mid-foot in children aged 2–16 years, and 24% and 36% specific for fractures of the ankle and mid-foot, respectively. Following the rules has the potential of reducing the number of ankle and mid-foot x-ray series by 16%–29%, according to the authors of the pediatric validation study.