CPR for Ankle Fracture

Ottawa Ankle Rules for excluding ankle and mid-foot fractures

Does the patient have:

  1. Inability to walk 4 steps immediately after an injury
  2. Localized tenderness of the posterior edge or tip of either malleoli
  3. Localized tenderness of the navicular bone or base of 5th metarsal

If they have either of 1-3 in addition to “pain in the midfoot or ankle”, they should be referred for an x-ray

Sensativity: 100%


Bachmann LM, Kolb E,  Koller MT, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review.British Medical Journal; 326: 417-19.


3 replies »

  1. what about the nausea, shock and tremors, bruising and swelling? These symptoms are more telling of an acute fracture than “tenderness” and weight-bearing (ie. distal fibula could be missed as it is a non-weight-bearing bone)

  2. Thanks for the comment Katherine…While there are alot of consistent signs and symptoms associated with ankle fractures, this set of criteria has been found statically to be a good screening guide for us to determine who likely has a fracture and needs an x-ray. That stated, many other criteria are often involved but these 3 items are the most consistent in the literature..In the end, if you believe someone has a fracture, get the x-ray…

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