Acute ankle injuries: clinical/radiologic assessment in diagnosis.
Acute ankle injuries represent a large burden of illness in the primary care/emergency setting. Concern has been expressed in the medical literature about the unnecessary use of X-rays in the assessment of these patients. A literature review was conducted to address the question: "Can clinical examination alone accurately diagnose fractures and sprains in patients with acute ankle injuries?" Published reports offer inconsistent conclusions on the value of clinical criteria in the diagnosis of fractures or sprains. These inconsistent conclusions appear to result from numerous biases, different patient populations studied, varied interpretations of normal and abnormal results, and different groups of examiners. The only criteria associated with the diagnosis of fracture in more than one study are age greater than 40 years, inability to bear weight on examination, "point" or "bone" tenderness, and swelling. Until consistent results are available, no change in the rate of X-ray referral should be expected.
S
S
Lloyd
N Engl J Med. 1982 Feb 11;306(6):333-9
7054709
Injury. 1983 May;14(6):507-12
6409805
Br Med J (Clin Res Ed). 1987 Apr 11;294(6577):943-7
3107669
Lancet. 1988 Jan 30;1(8579):244-5
2893070
Br Med J (Clin Res Ed). 1981 Feb 21;282(6264):607-8
6781589
Br Med J. 1963 Apr 20;1(5337):1056-60
13929965
Br Med J (Clin Res Ed). 1986 Sep 6;293(6547):603-5
3092948
Br Med J. 1979 Jun 16;1(6178):1597-8
111756
Injury. 1985 Sep;16(8):545-6
4066016
Can Med Assoc J. 1983 Jul 15;129(2):129-31
6407744