Variant 2: Adult or child 5 years of age or older. Acute trauma to the ankle. No exclusionary criteria present (eg, neurologically intact (including no peripheral neuropathy)). Patient meets the requirements for evaluation by the Ottawa Ankle Rules which are negative: No point tenderness over the malleoli, talus, or calcaneus on physical examination. Able to walk. Initial imaging. Bone Scan Ankle Bone scan is not routinely indicated as the first imaging study for evaluation of acute trauma to the ankle in this clinical scenario. CT Ankle CT is not routinely indicated as the first imaging study for evaluation of acute trauma to the ankle in this clinical scenario. MRI Ankle MRI is not routinely indicated as the first imaging study for evaluation of acute trauma to the ankle in this clinical scenario. Radiography Ankle Radiography is not routinely indicated as the first imaging study for evaluation of acute trauma to the ankle in this clinical scenario. US Ankle US is not routinely indicated as the first imaging study for evaluation of acute trauma to the ankle in this clinical scenario. Variant 3: Adult or child 5 years of age or older. Acute trauma to the ankle. Exclusionary criteria are present (eg, neurologic disorder, neuropathy, or other). Patient does not meet requirements for evaluation by the Ottawa Ankle Rules. Initial imaging. OAR should not be used in patients with neurologic abnormality involving the lower leg or those with decreased sensation (eg, diabetics), altered sensorium, or inability to communicate [25,26]. Other possible cautionary or exclusionary scenarios include pregnancy, penetrating trauma, or presence of prior recent outside radiographs on transfer. Acute Trauma to the Ankle Bone Scan Ankle Bone scan is not routinely used as the first imaging study for the evaluation of acute trauma to the ankle in the setting of peripheral neuropathy or other exclusionary criteria.
Acute Trauma to the Ankle. Variant 2: Adult or child 5 years of age or older. Acute trauma to the ankle. No exclusionary criteria present (eg, neurologically intact (including no peripheral neuropathy)). Patient meets the requirements for evaluation by the Ottawa Ankle Rules which are negative: No point tenderness over the malleoli, talus, or calcaneus on physical examination. Able to walk. Initial imaging. Bone Scan Ankle Bone scan is not routinely indicated as the first imaging study for evaluation of acute trauma to the ankle in this clinical scenario. CT Ankle CT is not routinely indicated as the first imaging study for evaluation of acute trauma to the ankle in this clinical scenario. MRI Ankle MRI is not routinely indicated as the first imaging study for evaluation of acute trauma to the ankle in this clinical scenario. Radiography Ankle Radiography is not routinely indicated as the first imaging study for evaluation of acute trauma to the ankle in this clinical scenario. US Ankle US is not routinely indicated as the first imaging study for evaluation of acute trauma to the ankle in this clinical scenario. Variant 3: Adult or child 5 years of age or older. Acute trauma to the ankle. Exclusionary criteria are present (eg, neurologic disorder, neuropathy, or other). Patient does not meet requirements for evaluation by the Ottawa Ankle Rules. Initial imaging. OAR should not be used in patients with neurologic abnormality involving the lower leg or those with decreased sensation (eg, diabetics), altered sensorium, or inability to communicate [25,26]. Other possible cautionary or exclusionary scenarios include pregnancy, penetrating trauma, or presence of prior recent outside radiographs on transfer. Acute Trauma to the Ankle Bone Scan Ankle Bone scan is not routinely used as the first imaging study for the evaluation of acute trauma to the ankle in the setting of peripheral neuropathy or other exclusionary criteria.