Additional views, such as axial calcaneal view, can be useful in patients with suspected calcaneal fracture [15] because addition of this view increases specificity in diagnosing calcaneal fractures and sensitivity in distinguishing intra-articular calcaneal fractures. Radiography Foot with Weightbearing If there are clinical signs of a Lisfranc injury, obtaining weightbearing radiographs is recommended when possible because nonweightbearing radiographs are not reliable for detection of subtle injuries. Weightbearing views have been shown to increase the abnormal alignment at the Lisfranc joint, thus making it easier to identify a Lisfranc injury [16,19]. The inclusion of both feet on AP radiographs can help in the detection of subtle malalignment when compared with the uninjured side [20]. CT Foot CT is commonly used in evaluating the true extent of osseous injury in complex fractures and at times is used as the initial imaging study in polytrauma patients and in complex regions such as the midfoot [21,22]. CT is not routinely used as the first imaging study for the evaluation of acute trauma to the foot with positive Ottawa rules when exclusionary criteria do not apply. MRI Foot MRI is not routinely used as the first imaging study for the evaluation of acute trauma to the foot with positive Ottawa rules. Acute Trauma to the Foot US Foot A preliminary US study had less successful results compared with radiographic evaluation, with 90.9% sensitivity and specificity for detecting fracture [13]. In the presence of localized tenderness, one study reported US sensitivity and specificity of 100% and 96% for fifth metatarsal fractures and 40% and 93% for navicular fractures, respectively [23]. A recent consensus paper from European Society of Musculoskeletal Radiology [14] assigned low grading scores for US assessment of talus and bony avulsions. Variant 3: Adult or child older than 5 years of age. Acute trauma to the foot. Ottawa rules cannot be evaluated due to exclusionary criteria.
Acute Trauma to the Foot. Additional views, such as axial calcaneal view, can be useful in patients with suspected calcaneal fracture [15] because addition of this view increases specificity in diagnosing calcaneal fractures and sensitivity in distinguishing intra-articular calcaneal fractures. Radiography Foot with Weightbearing If there are clinical signs of a Lisfranc injury, obtaining weightbearing radiographs is recommended when possible because nonweightbearing radiographs are not reliable for detection of subtle injuries. Weightbearing views have been shown to increase the abnormal alignment at the Lisfranc joint, thus making it easier to identify a Lisfranc injury [16,19]. The inclusion of both feet on AP radiographs can help in the detection of subtle malalignment when compared with the uninjured side [20]. CT Foot CT is commonly used in evaluating the true extent of osseous injury in complex fractures and at times is used as the initial imaging study in polytrauma patients and in complex regions such as the midfoot [21,22]. CT is not routinely used as the first imaging study for the evaluation of acute trauma to the foot with positive Ottawa rules when exclusionary criteria do not apply. MRI Foot MRI is not routinely used as the first imaging study for the evaluation of acute trauma to the foot with positive Ottawa rules. Acute Trauma to the Foot US Foot A preliminary US study had less successful results compared with radiographic evaluation, with 90.9% sensitivity and specificity for detecting fracture [13]. In the presence of localized tenderness, one study reported US sensitivity and specificity of 100% and 96% for fifth metatarsal fractures and 40% and 93% for navicular fractures, respectively [23]. A recent consensus paper from European Society of Musculoskeletal Radiology [14] assigned low grading scores for US assessment of talus and bony avulsions. Variant 3: Adult or child older than 5 years of age. Acute trauma to the foot. Ottawa rules cannot be evaluated due to exclusionary criteria.