Impact of the Ottawa Ankle Rules in a U.S. Army Troop Medical Clinic in South Korea

Abstract

The impact of the Ottawa Ankle Rules on radiograph-ordering behavior was assessed. Medical records and radiology reports for 80 consecutive patients who presented with the complaint of acute ankle pain were retrospectively reviewed for 18 variables. Twenty-two patients met the rules criteria and 45 did not. There were 10 fractures in the study group (N = 67), 3 of which were missed by the rules. All 3 fractures were 1-mm avulsion fractures of the fibula and are considered not clinically significant. Application of the Ottawa Ankle Rules by all clinic providers would have decreased the number of radiographs at our facility by 68%. The rules had sensitivity and specificity of 70% and 73%, and positive and negative predictive values of 31.8% and 93.3%, respectively. Providers at our facility did not routinely use the rules. Although the incorporation of these rules into our practice would have been significant, we recommend their use cautiously for a military population, which maintains a high intensity of physical training.