Ottawa rules for knee and ankles

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Ottawa rules are used to decide whether an injury needs an xray to rule out fractures or not.
 
Ankle rules:
x rays are needed if:
  • unable to weight bear after injury and at examination (take more than 4 steps)
  • tenderness of the posterior surface of the distal 6cm of the posterior lateral or medial malleolus.
  • Tenderness over base of 5th metatarsal bone
  • tenderness of the navicular or calcaneum.
 
Knee rules:
for any adult patient below 55, x rays are needed if:
  • there is isolated bony tenderness of the patella
  • there is bony tenderness over the fibula head
  • Patient cannot flex knee to 90 degrees
  • patient could not weiht bear after the injury and at the time of examination (take more than 4 steps)

 Have lower thresholds for patients reattending for the same injury, the young, the old, and those who are difficult to assess (eg. intoxicated)
 
Oxford handbook of emergency medicine, 3rd ed.

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