Ottawa Rules for X-Ray of K

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Ottawa rules for x-ray of knee, ankle and foot http://www.gp-training.net/rheum/ottawa.htm Ottawa ankle and foot rules An ankle x-ray is required only if there is any pain in malleolar zone and any of these findings: bone tenderness at A bone tenderness at B inability to weight bear both immediately and in the casualty department. A foot x-ray is required if there is any pain in the midfoot zone and any of these findings: bone tenderness at C bone tenderness at D inability to weight bear both immediately and in the casualty department. Ankle injuries are extremely common but many features on history and physical examination are unreliable The combined Ottawa ankle and foot rules have a sensitivity of 97.8% and a specificity of 31.5%, giving a negative likelihood ratio of 0.07; this will yield a post-test probability of about 1% for fracture of the ankle if test results are negative (not requiring x ray) Treatment for ligament injuries should include dynamic splinting and RICE (rest, ice, compression, and elevation) Rule out a complete tear of the ligaments by doing drawer testing of the ankle before discharging the patient or at the first follow-up visit Ottawa knee rules A knee x-ray is only required for knee injury patients with any of these findings: age 55 or over isolated tenderness of the patella (no bone tenderness of the knee other than the patella) tenderness at the head of the fibula inability to flex to 90 degrees inability to weight bear both immediately and in the casualty department (4 steps - unable to transfer weight twice onto each lower limb regardless of limping). Source: BMJ 1995, Bandolier 1998. BMJ 2009 1 of 1 9/24/2010 11:14 AM.

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Knee Flow Chart Acute
Symptom chart for acute knee pain START HERE Did the knee pain begin Does the knee joint You may have a fracture or Stop what you are doing immediately and go to a hospital emergency room YES YES suddenly, with an injury, appear deformed, or dislocated patella. or an orthopedic surgeon specializing in knee problems. slip, fall, or collision? out of position? If possible, splint the leg to limit the movement of the knee until you reach NO the doctor. Do not put any weight on the knee. Use a wheelchair, a cane, or NO crutch to prevent putting any weight on the leg, which might cause further damage to the joint. GO TO FLOW CHART #2 Go to an orthopedic surgeon Stop what you are doing. Continuing activity despite the feeling that the knee ON CHRONIC KNEE Did you hear a “pop” YES immediately, you may have is unstable can cause additional damage to other ligaments, meniscus , and PROBLEMS THAT DEVELOP and does your knee feel torn your anterior cruciate, or cartilage. Try ice on the knee to control swelling. Take anti-in ammatories OR WORSEN OVER TIME. unstable or wobbly? other ligaments in the knee. like Advil or Nuprin until your doctor’s appointment. About a third of ligament tears get better with exercises, a third may need a brace, and a third may need sur gery. NO Use R•I•C•E for sore knees Does your knee hurt YES You may have damaged the articular Try anti-in ammatories, as directed on the bottle, for two days to reduce R: Rest as you bend it? cartilage on the bottom of the the chronic in ammation.
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