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A Journal on Sports Medicine

Official Journal of the Italian Sports Medicine Federation
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Medicina dello Sport 2008 September;61(3):373-80


language: English, Italian

Validation of the Ottawa Ankle Rules in athletes: study in a II level Trauma Center

Santelli F. 1, Magnanelli R. 1, Pallotto R. 1, Formica L. M. 2, Polonara S. 3, Marinelli M. 1

1 Regional Centre of Sports Medicine, Ancona, Italy 2 Centre of Sports Medicine, Macerata, Italy 3 Acceptance and Emergency Medicine and Surgery Unit Orthopedic Clinic Hospitals Umberto I, GM Lancisi, G Salesi, Ancona, Italy


Aim. The aim of this study was to validate the Ottawa Ankle Rules (OARs) protocol for predicting ankle end midfoot fractures in athletes.
Methods. This prospective survey was conducted from July 2006 through October 2006 at the Ospedali Riuniti (Umberto I, GM Lancisi, G Salesi) Hospital Emergency Department; the study population was 248 amateur athletes presenting with acute ankle injury. The main outcome measures were sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios (positive and negative) of the OARs.
Results. The sensitivity of the OARs for detecting 42 ankle fractures (29 malleolar, 4 midfoot, 4 concomitant) in each of the two regions and in both regions was 100%. The specificity of the OARs for detecting fractures in both regions was 46.5%, 43.5% for malleolar fractures, and 41% for midfoot fractures. Implementation of the OARs had the potential to reduce the number of x-ray orders by 29%.
Conclusion. Foot and ankle injury is a common reason for Emergency Department visits. X-ray is routinely performed, even though the result is expected to be normal. Only approximately 15% of patients have clinically significant fractures. The OARs is a highly sensitive tool for detecting ankle and midfoot fractures. Implementation of the rules could considerably reduce the number of x-ray orders, costs, radiation exposure and waiting time in emergency departments.

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