HWN Suggests

Commonly Missed Ankle Injuries

You probably can’t remember the last time you worked a shift in the ED and didn’t see at least one patient with an ankle injury. While almost all of these patients are relatively straightforward to diagnose and manage a small but significant minority of these patients will have a more elusive diagnosis, that if not identified early, could lead to significant morbidity. On the flip side, if we’re super conservative and defensive and we immobilize everyone with an ankle injury no matter how minor we’re not doing our patients or our consultants any favors either.

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 Ottawa Ankle Rule

If the rule states imaging is required, rarely does a patient need both an ankle and foot x-ray, just one or the other or neither. If negative, most patients will heal quickly from a soft tissue ankle injury, but some may require physical therapy.

 Twisting and Turning - Ankle Injuries in the ED

Ankle injuries are among the most common reasons for ED visits. Ankle fractures are the third most common fracture in the ED and more than 20,000 patients are seen in the ED for ankle sprains each day. Ankle injuries have financial implications for both the healthcare system and patients.

Articles of Interest

Revisiting the humble ankle sprain

Ankle injuries are one of the most common presentations to the Emergency Department (ED), but few emergency physicians would consider them to represent a diagnostic challenge. In our armoury, we already have the Ottawa ankle rules (which are highly sensitive for bony injury) and access to plain radiographs. However, Deutekom et al present a systematic review of studies evaluating the diagnostic accuracy of ultrasound for ankle injuries. Why should we consider another diagnostic modality for such a straightforward injury? There are three good reasons.

Acute Ankle Injuries in the Urgent Care Setting

This article will provide a brief overview of ankle sprains, but will focus primarily on acute ankle fractures that result from minor trauma, including a basic approach to evaluation, management, and orthopedic referral of stable versus unstable ankle fractures. An ankle fracture is considered unstable if two or more sites of significant injury are present, such as a malleolar fracture and a ligamentous disruption or a bimalleolar fracture.

Ankle Injuries

This group of injuries varies in severity with different treatments, discharge instructions, and follow up plans based on the injury classification.. Ankle fractures also have a large degree of variability in severity and require different initial management. In this post, we will focus on the most common types of ankle injuries and discuss the most important steps for initial assessment, management, and discharge instructions ED clinicians should be giving to their patients.

Can’t Miss Adult Ankle and Foot Injuries

This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries.

Diagnostic accuracy of the Ottawa ankle rule to exclude fractures in acute ankle injuries in adults: a systematic review and meta-analysis

Application of the OAR is highly sensitive and can correctly predict the likelihood of ankle fractures when present, however, lower specificity rates increase the likelihood of false positives. Overall, the use of the OAR tool is supported as a cost-effective method of reducing unnecessary radiographic referral, that should improve efficiency, lower medical costs and reduce waiting times.