The Ottawa guidelines and ankle joints

Queried fractures to the ankle are among the most common presentations for patients in the emergency department (ED), diagnosed through clinical examination and radiographic imaging¹. Appropriate diagnosis is paramount for patients with trauma to the ankle, impacting their treatment pathway and prognosis. As a weight-bearing joint, a missed fracture can cause further pain and, in some cases, more significant, long-term injuries².

Injuries to the ankle joint constitute approximately 6-12% of all reasons for patient attendance in EDs, however less than 15% of this patient group will be diagnosed with a fracture to the ankle³. Although the incidence of fractures in this group is relatively low, over 70% of patients attending the ED with trauma to the ankle will be referred for a radiographic examination⁴. This means patients without a fracture are receiving an ionising radiation dose, and...