title: Minimising negative ankle and foot X-rays in the Emergency Department -- are the Ottawa ankle rules good enough?
abstract: OBJECTIVE
  To review fracture rates in patients who had X-rays of either the ankle or foot or both in the Emergency Department of a district hospital.
  
  
  METHODS
  A retrospective review of 2589 Emergency Department patients who had X-rays of the ankle or foot or both over a 12-month period.
  
  
  RESULTS
  There were 1199 ankle X-rays taken of which 193 (16%) showed a significant fracture. There were 1081 patients who had a foot X-rayed of which 165 (15%) showed a significant fracture. Younger patients had more X-rays but older patients were more likely to have a fracture. There were 309 patients who had an ipsilateral ankle and foot X-rayed at the same time, and of these 42 (14%) showed one fracture and just two (0.6%) showed a significant fracture of both ankle and foot.
  
  
  CONCLUSIONS
  The approach to X-raying ankle and feet in this study is probably widespread, and Ottawa Ankle Rules still seem to be of limited use in diagnosing fractures. This low yield of positive X-ray could be accepted or a more sophisticated ankle rule introduced.
authors.affiliation: The Princess Royal Hospital, Apley Castle, Telford TF1 6TF, United Kingdom. Electronic address: sebastien.crosswell@nhs.net.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Crosswell
authors.affiliation: The Princess Royal Hospital, Apley Castle, Telford TF1 6TF, United Kingdom. Electronic address: alan.leaman@sath.nhs.uk.
authors.forename: Alan
authors.initials: A
authors.lastname: Leaman
authors.affiliation: The Princess Royal Hospital, Apley Castle, Telford TF1 6TF, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Phung
mesh_terms: D000367:Age Factors; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics; D018409:Foot Injuries / Q000000981:diagnostic imaging*; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011859:Radiography; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology; D019564:Unnecessary Procedures; D016474:Weight-Bearing; D014965:X-Rays
keywords: Clinical assessment; Extremity; Fracture; Imaging; Musculo-skeletal; Ottawa ankle rules; Trauma; X-ray