TY - JOUR T1 - Revisiting the humble ankle sprain JF - Emergency Medicine Journal JO - Emerg Med J DO - 10.1136/emermed-2023-213287 SP - emermed-2023-213287 AU - David Metcalfe AU - Sarah Lancaster AU - David Keene Y1 - 2023/05/12 UR - http://emj.bmj.com/content/early/2023/05/12/emermed-2023-213287.abstract N2 - 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.1 Why should we consider another diagnostic modality for such a straightforward injury?There are three good reasons. First, plain radiographs do not detect all fractures around the ankle. Allen et al recruited 100 patients with ankle injuries that had normal radiographs despite fulfilling the Ottawa ankle rules.2 These patients all underwent CT and ultrasound imaging, which revealed 19 important fractures (lateral malleolus, posterior malleolus, calcaneus, cuboid and talus) and 43 avulsion fractures. Second, over-reliance on plain radiographs risks missing soft tissue injuries requiring specific orthopaedic management, such as peroneal tendon dislocation and syndesmotic rupture. Finally, plain radiographs centre the diagnostic process on identifying fractures, which may lead to undertreatment of … ER -