The Ottawa Ankle Rules indicate that an ankle radiograph is required if there is:
- A Swelling and tenderness over the anterior talofibular ligament
- B Anterior drawer test positivity indicating complete ATFL tear
- C Bone tenderness at the posterior edge or tip of the lateral or medial malleolus, OR inability to bear weight for 4 steps ✓
- D Any ankle sprain presenting to the emergency department within 48 hours
Explanation
The Ottawa Ankle Rules: ankle X-ray is needed if there is bony tenderness in the 'malleolar zone' (posterior edge/tip of fibula — distal 6 cm, OR posterior edge/tip of tibia — distal 6 cm) or inability to bear weight for 4 steps both immediately and in the ED. The Ottawa Foot Rules additionally indicate foot X-ray for midfoot bone tenderness (navicular or base of 5th metatarsal zone). These rules have 99%+ sensitivity for fractures and significantly reduce unnecessary X-rays. ATFL tenderness and anterior drawer positivity indicate ligament injury, not a fracture indication per Ottawa rules.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.