Imaging is required if there is pain in the midfoot zone and any of the following. This screening tool was developed because of the need for a rapid and accurate way to avoid unnecessary imaging. Ottawa ankle rules ottawa hospital research institute. Controlled clinical trial with beforeafter and concurrent. The ottawa knee rules okrs were first derived and validated in ottawa, canada, with the aim of reducing the number of unnecessary radiographs ordered after knee trauma without compromising patient care.
There are three sets of rules, one each for the foot, ankle and knee. Ottawa ankle rules for the injured ankle british journal. It consists of 5 criteria highly correlated with knee fracture status. Although validated in children, the ottawa knee rules were.
To assess the impact on clinical practice of implementing the ottawa knee rule. The ottawa rules for ankle, knee and spine now a mobile. Plain radiographs of the knee are among the most commonly ordered radiographs in u. The ottawa knee rule was derived to aid in the efficient use of radiography in acute knee injuries. Commentary validity testing has shown that use of the okr in adults can reduce the need for knee x rays without jeopardising clinical outcome. The ottawa knee rule is a previously validated clinical decision rule that was developed to allow physicians to be more selective and efficient in their use of plain radiography for patients with acute knee injuries. Pdf the accuracy of the ottawa knee rule to rule out knee. This screening tool was developed because of the need for a rapid and. Request pdf validation of the ottawa knee rule in children. Do not neglect the importance of medial malleolar tenderness. A multicenter study the main objective of this study was to determine the sensitivity and specificity of the ottawa knee rules when.
What is the best way to evaluate an acute traumatic knee. The ottawa knee rule, for example, resulted in a reduction of 26. The ottawa knee rules were derived to aid in the efficient use of radiography in acute knee injuries and. The accuracy of the ottawa knee rule to rule out knee. The ottawa knee rules are useful in ruling out fracture high sensitivity when negative, but poor for ruling in fractures many false positives. Ottawa knee rule ottawa hospital research institute. Acute knee injuries are very common and account for a significant number of presentations in general practice and hospital emergency department settings. Palpate the entire distal 6 cm of the fibula and tibia. The ottawa knee rule states that xray examination of the knee is indicated only if patients meet at least one of the five criteria. A clinical decision rule to determine the need for diagnostic imaging for ankle andor foot trauma.
While all of these rules can be used in patients under the age of 18, they should be used with caution. The ottawa knee rule is a validated clinical decision rule for determining whether knee radiographs should. The rate of ottawa knee rule compliance was retrospectively determined to be 63. The ottawa knee rules accurately identified fractures in. It has been prospectively validated on multiple occasions in. The ottawa knee rules calculator determines whether the patient requires knee xray for knee injury. The ottawa knee rules are a set of rules used to help physicians determine whether an xray of.
The ottawa knee rule describes criteria for minor knee trauma patients that are so low risk as not to warrant knee imaging. They state that an xray is required only in patients who have an acute knee injury with one or more of the following. A negative result on an ottawa knee rule test accurately excluded knee fractures after acute knee injury. The ottawa ankle rules modified buffalo rule the buffalo rule was derived to increase the diagnostic accuracy of the ottawa ankle rules, with the point tenderness criterion directed to the crest or midportion of the malleoli distal 6 cm of the fibula and tibia, reducing the likelihood of palpating over injured ligament structures. Radiography for knee trauma compliance with the ottawa. A clinical decision rule to determine the need for diagnostic imaging for knee trauma. Ottawa knee rule the ottawa hospital research institute. Tenderness of patella is significant only if an isolated finding. Prospective validation of a decision rule for the use of radiography in acute knee injuries. The ottawa knee rules are a set of rules used to help physicians determine whether an xray of the knee is needed. Ottawa knee rule for use of radiographs in knee injury. Use only for injuries ottawa rules for xray of knee, ottawa ankle and foot rules lateral view ankle and foot medial view posterior edge or tip of medial malleolus navicular malleolar zone midfoot zone posterior edge or tip of lateral malleolus base of 5th metatarsal 6cm an ankle xray is required only if there is any pain in malleolar zone and any of these findings. The rule has been validated in numerous studies both in children although not recommended as sole decision rule and adults.
The parameters used in the calculator include age, isolated tenderness of patella, inability to flex 90 degrees, inability to gear weight both immediately and in the emergency department. The rules, developed by emergency department physicians at the ottawa hospital and the university of ottawa, are applied to the ankle, knee or. The ottawa knee rules accurately identified fractures in children presenting to the emergency department with a knee injury. The ottawa knee rules a useful clinical decision tool racgp. The ottawa knee rules determine the need for radiographs in acute knee injuries.
Pdf the ottawa knee rule is a clinical decision aid that helps rule out fractures and avoid unnecessary radiography. Specific physical examination maneuvers such as the lachman and mcmurray tests may be helpful when assessing for meniscal or ligamentous injury. Patients who do not meet the fracture predictor of the okrs are highly unlikely to have clinically. Racgp the ottawa knee rules a useful clinical decision. The ottawa ankle rule is useful for ruling out fracture high sensitivity, but poor for ruling in fractures many false positives. Use only for injuries 55 tenderness at head of fibula tenderness on patella inability to complete 4 steps bear weight immediately and in the ed inability to flex to 90 degrees. Knee rule for knee injury radiography a knee xray series is only required for knee injury patients with any of these findings.
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