title: Ottawa ankle rules and subjective surgeon perception to evaluate radiograph necessity following foot and ankle sprain.
abstract: BACKGROUND
  Foot and ankle injuries are frequent in emergency departments. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns are almost always simple, lack of fracture diagnosis can lead to poor functional outcomes.
  
  
  OBJECTIVE
  The present study aims to evaluate the reliability of the Ottawa ankle rules and the orthopedic surgeon subjective perception to assess foot and ankle fractures after sprains.
  
  
  METHODS
  A cross-sectional study was conducted from July 2012 to December 2012. Ethical approval was granted. Two hundred seventy-four adult patients admitted to the emergency department with foot and/or ankle sprain were evaluated by an orthopedic surgeon who completed a questionnaire prior to radiographic assessment. The Ottawa ankle rules and subjective perception of foot and/or ankle fractures were evaluated on the questionnaire.
  
  
  RESULTS
  Thirteen percent (36/274) patients presented fracture. Orthopedic surgeon subjective analysis showed 55.6% sensitivity, 90.1% specificity, 46.5% positive predictive value and 92.9% negative predictive value. The general orthopedic surgeon opinion accuracy was 85.4%. The Ottawa ankle rules presented 97.2% sensitivity, 7.8% specificity, 13.9% positive predictive value, 95% negative predictive value and 19.9% accuracy respectively. Weight-bearing inability was the Ottawa ankle rule item that presented the highest reliability, 69.4% sensitivity, 61.6% specificity, 63.1% accuracy, 21.9% positive predictive value and 93% negative predictive value respectively.
  
  
  CONCLUSIONS
  The Ottawa ankle rules showed high reliability for deciding when to take radiographs in foot and/or ankle sprains. Weight-bearing inability was the most important isolated item to predict fracture presence. Orthopedic surgeon subjective analysis to predict fracture possibility showed a high specificity rate, representing a confident method to exclude unnecessary radiographic exams.
authors: Department of Orthopedic Surgery, Felício Rocho Hospital, Belo Horizonte-MG, Brazil ; Department of Orthopedic Surgery, Federal University of Minas Gerais, Belo Horizonte-MG, Brazil.
authors: Res
authors: R
authors: Pires
authors: Department of Orthopedic Surgery, Federal University of Minas Gerais, Belo Horizonte-MG, Brazil.
authors: Aa
authors: A
authors: Pereira
authors: Department of Orthopedic Surgery, Felício Rocho Hospital, Belo Horizonte-MG, Brazil.
authors: Gm
authors: G
authors: Abreu-E-Silva
authors: Department of Orthopedic Surgery, University of Petrópolis, Petrópolis-RJ, Brazil.
authors: Pj
authors: P
authors: Labronici
authors: Department of Orthopedic Surgery, Felício Rocho Hospital, Belo Horizonte-MG, Brazil.
authors: Lb
authors: L
authors: Figueiredo
authors: Department of Orthopedic Surgery, University of São Paulo, São Paulo-SP, Brazil.
authors: Al
authors: A
authors: Godoy-Santos
authors: Department of Orthopedic Surgery, University of São Paulo, Ribeirão Preto-SP, Brazil.
authors: M
authors: M
authors: Kfuri
keywords: Ankle; Ankle fractures; Ankle injuries; Foot; Fractures