title: Evaluating fracture risk in acute ankle sprains: Any news since the Ottawa Ankle Rules? A systematic review.
abstract: BACKGROUND
  Ankle sprain is frequently encountered, both in primary care and in emergency departments. Since 1992, the Ottawa ankle rules (OAR) can assist clinicians in determining whether an X-ray should be performed to exclude a fracture. Several guidelines recommend the use of OAR based on a systematic review from 2003. Ten years later, one can wonder if this recommendation should be changed.
  
  
  OBJECTIVE
  To review systematically the current evidence on the most accurate method to assess the fracture risk after an ankle sprain in adults.
  
  
  METHODS
  A methodical search for systematic reviews, meta-analyses and primary studies was carried out in Medline, Cochrane Database of systematic reviews, Embase, Pedro, CINAHL, Medion and specific guideline search engines. At least two independent researchers performed selection, quality appraisal (with validated checklists) and data extraction.
  
  
  RESULTS
  One systematic review and 21 primary studies were selected. Sensitivity and specificity of the OAR range from 92-100% and from 16-51%, respectively. To improve the OAR specificity, other tools are proposed such as the Bernese ankle rules. Vibrating tuning fork test and ultrasound could be useful in patient with OAR positive to decrease the need for radiographs. No evidence was found in favour of the use of magnetic resonance imaging (MRI) or computed tomography (CT) in the acute phase of ankle sprain.
  
  
  CONCLUSIONS
  The findings confirm the value of the OAR at ruling out fractures after an ankle sprain and propose other or additional tools to decrease the need for X-rays.
authors.affiliation: a Belgian Health Care Knowledge Centre , Belgium ;
authors.forename: Pascale
authors.initials: P
authors.lastname: Jonckheer
authors.affiliation: b Department of Physiotherapy and Orthopedics , Ghent University , Belgium ;|c Department of Rehabilitation Sciences and Physiotherapy , Ghent University , Belgium ;
authors.forename: Tine
authors.initials: T
authors.lastname: Willems
authors.affiliation: c Department of Rehabilitation Sciences and Physiotherapy , Ghent University , Belgium ;
authors.forename: Roel
authors.initials: R
authors.lastname: De Ridder
authors.affiliation: a Belgian Health Care Knowledge Centre , Belgium ;
authors.forename: Dominique
authors.initials: D
authors.lastname: Paulus
authors.affiliation: a Belgian Health Care Knowledge Centre , Belgium ;
authors.forename: Kirsten
authors.initials: K
authors.lastname: Holdt Henningsen
authors.affiliation: a Belgian Health Care Knowledge Centre , Belgium ;
authors.forename: Lorena
authors.initials: L
authors.lastname: San Miguel
authors.affiliation: d Department of Family Medicine and Primary Health Care , Ghent University , Belgium.
authors.forename: An
authors.initials: A
authors.lastname: De Sutter
authors.affiliation: c Department of Rehabilitation Sciences and Physiotherapy , Ghent University , Belgium ;
authors.forename: Philip
authors.initials: P
authors.lastname: Roosen
mesh_terms: D000208:Acute Disease; D000328:Adult; D064386:Ankle Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016512:Ankle Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D017410:Practice Guidelines as Topic; D012306:Risk; D012680:Sensitivity and Specificity
keywords: Ankle injuries; diagnosis; general practice; primary care; systematic review