In an effort to save time and resources, some institutions use a two-view approach (lateral PLUS either AP or mortise), but this has a sensitivity of only 85-98%. The mortise view is taken in 15-20 degrees of internal rotation with x-ray beams projecting perpendicular to the intermalleolar line. The initial radiographic evaluation of the ankle involves three views (lateral, AP, and mortise). Mortise view Lateral view What is the sensitivity of ankle x-rays? 3 However, at a similar rate, patients who underwent imaging had the x-rays initially read as negative. One of the original multi-center validation studies for Ottawa ankle rules in 1995 revealed a 0.5% fracture miss rate, mostly because providers misused the clinical decision rule or in one case had difficulty assessing the grossly swollen ankle. 3,4 Similar sensitivity results are seen in pediatric populations, with near 100% sensitivity when categorizing Salter-Harris Type I as clinically insignificant due to low complication rate. When x-rays are ordered based on the Ottawa ankle rules, multiple studies have shown sensitivity at nearly 100% in adult populations while decreasing the number of x-rays ordered by 20-40%. Unable to bear weight both immediately and in the ED.Ottawa ankle rules: Ankle X-rays if pain in the malleolar zone PLUS one of the following: Since its derivation and validation in 1992, the Ottawa ankle rules are the most frequently used clinical decision tool when considering to obtain ankle x-rays. While sprains are the most common injuries (most common = anterior talofibular ligament), the patient still needs to be assessed for fracture. Traumatic ankle pain is a common presenting problem to emergency departments. There is swelling and ecchymosis diffusely with tenderness at the tip of the lateral malleolus. Author: Jeremy Kim, MD (EM Resident Physician, Icahn School of Medicine at Mount Sinai) // Edited by: Alex Koyfman, MD EM Attending Physician, UTSW / Parkland Memorial Hospital) & Justin Bright, MD Clinical ScenarioĪ 25-year-old male presents with a left ankle injury while playing basketball.
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