When do you get an x-ray to evaluate an ankle injury?

At some point in your outpatient clinic, you will have a patient with an ankle injury. Maybe they tripped on the curb. Maybe they stepped wrong on a stair. Anyway, they’re here in your office, and the #1 thought on their mind is probably: is it broken?

Their ankle looks kind of swollen and bruised on exam, and they wince when you so much as put your fingertip on their skin. So do you get an x-ray? Or not?

Luckily, there are rules to guide us. The Ottawa Ankle Rules have a sensitivity of virtually 100% and okay specificity. This is what it boils down to: if they can’t bear weight on that leg AND they have pain around their ankle or the 5th metatarsal, get an x-ray.

What you do next depends on what the x-ray shows. If there was no fracture–only a sprain–I would have told her to move around to the best of her ability and RICE it. (RICE=rest, ice, compression, elevation) If there was a fracture, I would have made an urgent orthopedics appointment so that she could get a cast.

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