![]() I came across this article by Dissman and Han in 2006. After speaking with her, examining her walking in the clinic (more than 4 steps), the time frame from injury over 24 hours ago and her opinion that it was only a sprain-all gave me a hunch that she did not, but went with the clinical guidelines. So, the average 13% of inversion injuries that are fractures could be more around 5-7%, even lower! Therefore, the rate of false positives would be even higher. I would suggest the probability of an ankle fracture arriving in a physical therapy office is much lower than at an emergency room (where initial rules arose), therefore, the specificity of this test would be even lower. Therefore, it got me thinking more about how to fine tune the specificity of the Ottawa Ankle Rules, as they only have ~32% specificity, which is very low. ![]() She sought care from PCP, had x-rays and they were negative. She had a positive finding on the Guidelines and it would be best to seek out a plain film radiograph. My course of action was education that I did not think she had a fracture, but I could not rule it out 100%. She also had negative provocation to moderate depth palpation to the anterior talofibular ligament and posterior calcaneofibular ligament.Īdditionally, she had negative pain provocation with 128hz tuning fork at location B and ~4” above this location along fibula shaft. Positive Ottawa Ankle Rules with Bone Tenderness at B, but negative for other realms of the guidelines. She had apparent swelling in the lateral/inferior aspect of the rearfoot with ecchymosis noted in this region as well (black/blue, not yellow). She acknowledged that she was able to walk immediately following the accident and feels symptoms are getting better. Upon examination, she was able to walk into the office but marked antalgic gait pattern using a standard cane (which she always uses). She was currently being treated in our clinic for balance and hip pain, but hasn’t sought care from a medical physician for current complaint. I had a female patient come into the office the other day complaining of left ankle pain following tripping on the ice the day before after leaving her home having an inversion ankle injury.
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