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  1. Jonathan Wyatt,
  2. Simon Hunter,
  3. Kal Murali
  1. Correspondence to:
 Mr J P Wyatt:

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Edited by Jonathan Wyatt; this scan coordinated by Simon Hunter and Kal Murali

Fewer ankle radiographs in the paediatric population ▸


Acute ankle injury is a common presentation among children in the emergency department. There is a fear of missing serious injury among doctors and there is often an expectation of parents and patients that a radiography will be performed. The Ottawa ankle rules (OAR) reduce the need for radiographs in an adult population, but when applied to children would result in many radiographs as a result of unwillingness to weight bear and/or findings isolated to the distal fibula or adjacent lateral ligaments. This clinical picture covers the diagnosis of Salter-Harris type I fractures, which have an excellent prognosis and having been diagnosed clinically, little is added by radiography. The authors postulated that in children with clinical findings restricted to distal fibula, lateral ligaments or both, radiographs would not influence acute management. The study aimed to identify those patients in this group who had fractures with a risk of serious complications.


Children aged between 3 and 16 years with isolated ankle fractures were recruited. Exclusion criteria included those with pre-existing musculoskeletal disease, coagulopathy, developmental delay or recent surgery/injury to the same ankle. Instruction in examination of ankles was given and a standard sheet for reporting clinical findings was prepared. Follow up occurred in an orthopaedic clinic or by telephone. “Low risk” examination findings were tenderness confined to distal fibula or lateral ligaments. “High risk” examinations were all others, including those with a history of unusual mechanism or force. “Low risk” diagnoses included sprains, contusions, avulsion fractures, and non-displaced Salter-Harris I and II fractures. All other fractures were “high risk”.


1017 patients with acute ankle injury were seen and of these 607 were enrolled. A total of 381 had low risk examinations and 226 had high risk findings. None …

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  • Scanned by
 J P Wyatt, Department of Accident and Emergency, Royal Cornwall Hospital, Treliske, Truro, Cornwall TR1 3LJ, UK; S Hunter, Department of Accident and Emergency, Southampton General Hospital, Soutnampton, UK; K Murali, Accident and Emergency Department, Selly Oak Hospital, Birmingham, UK