Ankle Injuries
Conditions
Keywords
Ottawa Ankle and Foot Rules, Buffalo Rule, Bernese Ankle Rules, Low Risk Exam, Malleolar Zone Algorithm, Clinical decision rule, Ankle injury, Ankle sprain, Inversion trauma
Brief summary
Comparison of the reliability of different examination techniques to detect fractures in patients with ankle trauma.
Detailed description
Patients with ankle trauma frequently present in the emergency department. In many institutions radiographies of the ankle and foot are obtained in most of these patients, although significant fractures occur only in 15%. Therefore clinical decision rules were developed to clinically rule out significant ankle fractures, thereby reducing the number of radiographies resulting in significant time and cost savings. Up until now the Ottawa Ankle and Foot Rules are the only clinical decision rules for ankle trauma that are widely accepted. They have a high sensitivity for the detection of fractures but a relatively low specificity. This led to the development of alternative clinical decision rules claiming equally high sensitivity but improved specificity. These alternatives have mostly not been replicated nor have they been directly compared. This is what the researchers want to do in this study: compare different clinical decision rules regarding sensitivity and specificity. Radiographies of ankle and foot made for every patient are used as the gold standard for the detection of fractures. Different clinical decision rules will be compared in a pediatric (5-15 years) and an adult population (from 16 years onwards). The researchers consider a clinical decision rule acceptable of it has a sensitivity of at least 95% and a specificity of at least 25%.
Interventions
PROCEDUREOttawa Ankle and Foot Rules
As previously published
PROCEDUREBuffalo Rule
As previously published
PROCEDUREOttawa Ankle and Foot Rules + application of a tuning fork to the distal fibula and tibia
As previously published
PROCEDUREThompson Test
As previously published
PROCEDUREPalpation of the fibula
Palpation of the fibula over its entire length.
PROCEDUREOttawa Ankle and Foot Rules + palpation of the cuboid bone
As previously published
PROCEDUREOttawa Ankle and Foot Rules + palpation over the deltoid ligament
As previously published
PROCEDUREMalleolar Zone Algorithm
As previously published
PROCEDURELow Risk Exam
As previously published
PROCEDUREBernese Ankle Rules
As previously published
PROCEDUREOttawa Ankle and Foot Rules + swelling of the distal fibula
As previously published
Sponsors
KU Leuven
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
5 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Pain due to blunt trauma to the ankle * Must be at least 5 years old
Exclusion criteria
* Skin defects in the injured area * Time of trauma \> 72 hours before presentation * Multiple significant injuries making clinical examination impossible * Clinically obvious fracture * Re-evaluation * Referred with radiography * Result of radiography already known to investigator * Glasgow Coma Scale \< 15
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Sensitivity for detection of significant fractures | At the first visit to the emergency department | * In the adult population: fractures of the ankle, midfoot or fibula with a fragment measuring \> 3mm detected by radiography * In the pediatric population: fractures of the ankle, midfoot or fibula with a fragment measuring \> 3mm detected by radiography. Salter-Harris I and II are not considered to be significant fractures. Due to considerable controversy in the literature sensitivity and specificity of the clinical decision rules will be calculated separately for different definitions of significant fractures. |
| Specificity for detection of significant fractures | At the first visit to the emergency department | * In the adult population: fractures of the ankle, midfoot or fibula with a fragment measuring \> 3mm detected by radiography * In the pediatric population: fractures of the ankle, midfoot or fibula with a fragment measuring \> 3mm detected by radiography. Salter-Harris I and II are not considered to be significant fractures. Due to considerable controversy in the literature sensitivity and specificity of the clinical decision rules will be calculated separately for different definitions of significant fractures. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of proximal fibula fractures in ankle trauma | At the first visit to the emergency department | The prevalence of proximal fibula fractures in ankle trauma has, to the best of our knowledge, not yet been quantified. |
| Prevalence of gastrocnemius tendon rupture in ankle trauma | At the first visit to the emergency department | The prevalence of gastrocnemius tendon rupture in ankle trauma has, to the best of our knowledge, not yet been quantified. |
Countries
Belgium
Contacts
Primary ContactDimitri Vandoninck, MD
Backup ContactMarc Sabbe, MD, PhD
Outcome results
None listed