Acute ankle injuries: clinical decision rules for radiographse

The need to perform "routine" radiographs after every case of ankle trauma has been repeatedly questioned, since less than 15 percent of ankle injuries are found to involve a significant fracture. Several authors have proposed guidelines to define clinical characteristics that may help physicians identify patients with a higher probability of having a fracture on the radiograph. The Ottawa ankle rules are the latest guidelines developed for the management of ankle injuries. These highly sensitive decision rules may allow a significant reduction in the number of ankle radiographic series ordered and may decrease patients' waiting times and costs without an increased rate of missed fractures or patient dissatisfaction.