Ottawa Ankle Rules define criteria to avoid unnecessary X-rays in acute ankle injuries. An X-ray is indicated if there is bony tenderness at which specific anatomical points?

• A Tenderness along the anterior talofibular ligament OR the calcaneofibular ligament
• B Tenderness at the posterior edge or tip of the lateral malleolus (posterior 6 cm) OR medial malleolus (posterior 6 cm), OR inability to weight-bear 4 steps ✓
• C Tenderness anywhere over the dorsum of the foot with more than mild swelling
• D Tenderness over the peroneal tendons posterior to the lateral malleolus

Explanation

Ottawa Ankle Rules state that ankle X-ray is required if there is bony tenderness in the 'malleolar zone' — specifically at the posterior edge or tip of either malleolus (posterior 6 cm of fibula or tibia) — OR inability to bear weight for four steps both immediately after injury and in the emergency department. Soft tissue tenderness over ligaments (option A) is NOT an indication. The Ottawa Foot Rules (for midfoot X-ray) add tenderness at the base of 5th metatarsal or navicular. The rules have >98% sensitivity for clinically significant fractures and have reduced unnecessary X-rays by ~30%.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.