Diagnostic Accuracy of Ottawa Ankle Rules in Acute Ankle Injuries in Patients Above Five Years of Age

Ottawa Ankle Rules Accuracy in Acute Ankle Injuries

Abstract

Ankle injuries are a common reason for emergency visits, but only 15% have fractures. The Ottawa Ankle Rules were introduced to reduce unnecessary imaging. Objective: To assess the diagnostic accuracy of Ottawa ankle rules in predicting ankle fractures and identify the main clinical predictors. Methods: This analytical cross-sectional study was conducted in the emergency department of  Ghurki Trust and Teaching Hospital, Lahore, from July 2024 and March 2025 on consecutive patients with acute ankle trauma. OAR was used to evaluate patients, followed by radiography. Calculations were done on sensitivity, specificity, PPV, and NPV. Data were analyzed using frequencies and percentages for categorical variables and means with standard deviation for continuous variables. Results: In this cohort of 71 patients (66.2% male; mean age 36.6 ± 15.3 years), falls and road traffic accidents were the primary injury mechanisms. X-rays revealed fractures in 69.0% of the cases. The Ottawa Ankle Rules (OAR) achieved a sensitivity and negative predictive value of 100%, although the specificity was low at 13.6%, leading to 19 false-positive results. Notably, medial malleolus pain (p<0.001) and inability to bear weight (p=0.003) were the strongest predictors of fracture. Conclusion: Our study demonstrated 100% sensitivity and negative predictive value for detecting fractures and no false negatives, but specificity was low at 13.6%, resulting in 19 false positives. Fractures were present in 69.0% of cases and were found mostly to be bimalleolar (25.4%) and tri-malleolar (18.3%). Medial malleolus pain and inability to bear weight had the strongest capability to predict fractures clinically.