Ankle Injury: Ottawa Rules

Key points

• The Ottawa Rules for ankle x-rays have a sensitivity approaching 100%
• An ankle x-ray is only required if there is pain in the malleolar zone AND any one of: bony tenderness at the lateral malleolar zone (distal 6cm of the posterior fibula), bony tenderness at the medial malleolar zone (distal 6cm of the posterior tibia), or inability to weight-bear for 4 steps immediately after the injury and in the emergency department
• Separate Ottawa Rules also exist for foot and knee injuries