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Ottawa Rules

cdr_knee_card cdr_ankle_poster

Knee and ankle injuries are something the we as EMS providers deal with on a fairly regular basis and determining whether or not a patient needs imaging can be tough.  So what do you do? Load the patient in the ambulance and take them to the hospital for exam and treatment by a physician. The patient gets an X-RAY, a very expensive bill, and if you’re in a busy system the already overloaded emergency room is taxed even more just to determine that there was no bony fracture or significant injury to the extremity and the patient gets sent home with crutches and some pain medicine and told to stay off it for a while. What if there was a way for emergency personnel to determine if it is really necessary to take a knee or an ankle injury to the hospital for imaging?

Well…there just happens to be a set of criteria to help emergency clinicians determine the necessity of imaging on a knee or ankle injury. The Ottawa ankle, foot and knee rules were developed by a group of emergency physicians at Ottawa Civic Hospital in 1992. The idea behind the development of the criteria was to reduce patient presentation to the emergency room for costly, time consuming and often times non necessary imaging. The rules are a very simple and easy set of criteria to remember and have proven to be highly sensitive (98.5 %) in determining whether or not imaging was necessary. Unfortunately teaching these rules to patients does not seem to reduce presentation at the emergency room even though when they were first developed they reduced the number of x-rays by 36%

Ottawa Ankle Rules

  1. Bone tenderness along the distal 2 inches of the posterior edge of the tibia or the tip of the medial malleolus.
  2. Bone tenderness along the distal 2 inches of the posterior edge of the fibula or the tip of the lateral malleolus.
  3. Inability to bear weight both immediately after the injury or upon presentation at the emergency department for four steps.

Ottawa Foot Rules

  1. Bone tenderness at the base of the fifth metatarsal.
  2. Bone tenderness at the navicular bone.
  3. Inability to bear weight immediately afte the injury or upon presentation at the emergency department for four steps.

Ottawa Knee Rules

The knee rules are slightly more intricate than the ankel and foot rules but still relatively simple.

  1. Patient is 55 or older.
  2. Tenderness at the head of the fibula
  3. Isolated tenderness of the patella.
  4. Inability to flex 90 degrees
  5. Inability to bear weight immediately after the injury or upon presentation at the emergency department for four steps.

If the patient does not meet any one of the criteria they need to be seen for imaging and further care by a physician. Patient care is simple with RICE (rest, ice, compression, elevation) treatment; pain management if the patient is significantly uncomfortable allowing the patient to find a position that is most comfortable to them.

Reference:

Ottawa ankle rules. (2014, August 16). In Wikipedia. Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Ottawa_ankle_rules

Ottawa knee rules. (2014, November 30). In Wikipedia. Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Ottawa_knee_rules