Ankle Injuries

akulahawkRN, ADN, RN, EMT-P · Apr 6, 2014

Ottawa ankle rules. Tenderness and weight bearing capability will help direct your actions.

jackpp · Apr 7, 2014

That's exactly what I was looking for. Thank you for sharing.

SnowShoeRN · Apr 7, 2014

There's actually a smartphone app that has the Ottawa ankle rules on it. I wish I could remember which one is it is...But yeah. I second.

akulahawkRN, ADN, RN, EMT-P · Apr 7, 2014

Just search for Ottawa Ankle Rules on your favorite smart phone app store and you should find an app that outlines the criteria. There's a LOT more to properly evaluating these injuries than what I can go into here, but the Ottawa Anke Rules should at least help point you toward who needs an x-ray and who likely doesn't.

NutmeggeRN, BSN · Apr 16, 2014

Just search for Ottawa Ankle Rules on your favorite smart phone app store and you should find an app that outlines the criteria. There's a LOT more to properly evaluating these injuries than what I can go into here, but the Ottawa Anke Rules should at least help point you toward who needs an x-ray and who likely doesn't.

Just looked Ottowa Rules up and it states not indicated for those under age 18...would you still recommend that as a guideline?

SnowShoeRN · Apr 19, 2014

Not sure where you read that (and I'm not trying to refute your point - just curious), but several studies have found the OAR to have between 80-100% sensitivity and 24-36% specificity in children over the age of 6. I'm not sure about children under 6, but chances are - at a camp at least - we aren't working with that age range. The general consensus seems to be the older the child the more sensitive it is. I've also seen MD's use it for pediatric patients - younger teens - but of course that's not to say MD's know everything. As for whether or not the AMA or any other professional organizations have an official stance on it, I don't know. I do know I've used it on kids and adults and have personally found it to be very helpful and sensitive.

CampNurse1 · May 23, 2014

I was an orthopedic technologist and an orthopedic first assistant for many years in another life.

I remember a fairly common scenario at the sports medicine clinic I used to work for: A client would come in with pain, edema, decreased ROM, etc., but the ankle film would be negative. The Dr. would dx sprain, have me put them in an ankle stirrup, and send them on their way. 7 - 10 days later, they would f/u, still complaining of pain, edema, etc., so we'd get another x-ray. There it would be, a thin white line of new bone, a sign of a healing micro-fracture which was invisible a week ago. Other significant injuries, such as avulsions, can be very subtle and can mimic a soft tissue injury.

Do a good exam: pain level, extent and class of edema, look for crepitus, deformity, do a good NV check. Document well and f/u. If in doubt, send them out. Let the doctor figure it out. For me, I am getting too close to diagnosing if I don't send a borderline case. If I am right, great, but if I am wrong, not so good. At the very least, call the camp doctor and the camper's parents and do what they say. Also, if you call the parent, even if you don't send the camper out, they are now in the picture and will not get any surprises at check-out. This prevents you from getting a phone call from mom two weeks later telling you Junior is in a cast and why didn't you take him to a doctor? I am not sure of your circumstances, but all of my campers have health insurance, so I don't have to worry too much about resources. I try not to torture our camp staff with trips to the ER, but ya gotta do what ya gotta do.

A good thing to do is to look for trends and to be proactive. If, say, you get three ankle injuries down at the ball field that week, ask the Camp Director to find out what's going on at the ball field.

The Ottawa Rules are outstanding, BTW.

SnowShoeRN · May 30, 2014

Qx Calculate is the app that I use. I couldn't remember the name of it before.

NutmeggeRN, BSN · Jun 11, 2014

Not sure where you read that (and I'm not trying to refute your point - just curious), but several studies have found the OAR to have between 80-100% sensitivity and 24-36% specificity in children over the age of 6. I'm not sure about children under 6, but chances are - at a camp at least - we aren't working with that age range. The general consensus seems to be the older the child the more sensitive it is. I've also seen MD's use it for pediatric patients - younger teens - but of course that's not to say MD's know everything. As for whether or not the AMA or any other professional organizations have an official stance on it, I don't know. I do know I've used it on kids and adults and have personally found it to be very helpful and sensitive.

http://www.ohri.ca/emerg/cdr/docs/cdr_ankle_poster.pdf

That was my source....hmmmm..need to further research this

CampNurse1 · Jun 11, 2014

Thanks for the link, Nutmegge! Printed and in my Health Center.

SnowShoeRN · Jul 2, 2014

This was one of the sources re using it in children:

Validation of the Ottawa Ankle Rules in child... [Acad Emerg Med. 1999] - PubMed - NCBI

I found a bunch of articles on it last fall for my clinical placement, but this is the only one I saved in my bookmarks on my computer.

I also found this one which is a little more recent:

http://adc.bmj.com/content/90/12/1309.full

There are more out there. I think more research needs to be done, really. That is, it may not be "approved" for children but I still think it bears consideration and can be very useful.