Comparison of current local practice and the Ottawa Ankle Rules to determine the need for radiography in acute ankle injury.

Ankle injuries are a frequent cause of attendance to accident and emergency (A&E) departments. Although often classed as 'minor injuries', the consequences of mismanagement can be debilitating for patients. In addition, it is not always easy to differentiate those injuries with bony fractures from solely ligamentous injuries, and most patients are radiographed unnecessarily. Clinical prediction rules such as the Ottawa Ankle Rules have been devised to reduce the degree of radiographic requests, thus limiting harmful radiation exposure, and reducing departmental costs. The A&E environment of our centre often includes a variety of clinicians with little pure orthopaedic training or knowledge of these clinical prediction rules, hence, providing a prime atmosphere for their assessing their effectiveness. A prospective study was performed in our centre to investigate the validity of the clinician's decision in diagnosis of a bony injury in the absence of training with the Ottawa Ankle Rules. The effectiveness of applying the rules was then determined on the same set of patients.