Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Acute Trauma to the Ankle possible cautionary or exclusionary scenarios include pregnancy, penetrating trauma, or presence of prior recent outside radiographs on transfer. Special Imaging Considerations Avoidance of manipulation of the ankle prior to radiographs in the absence of neurovascular deficit or critical skin injury is recommended in order to avoid remanipulation or complication in this setting [27]. Advances in MRI technology have facilitated short dedicated extremity MRI protocols in some centers that may be used as an emergent adjunct to radiographs [28]. OR Discussion of Procedures by Variant Variant 1: Adult or child 5 years of age or older. Acute trauma to the ankle or acute trauma to the ankle with persistent pain for more than 1 week but less than 3 weeks. No exclusionary criteria present. Initial imaging. Patient meets the requirements for evaluation by the Ottawa Ankle Rules which are positive: 1. Inability to bear weight immediately after the injury, OR 2. Point tenderness over the medial malleolus, the posterior edge or inferior tip of the lateral malleolus, 2. Point tenderness over the medial malleolus, the posterior edge or inferior tip of the lateral malleolus, talus, or calcaneus, OR 3. Inability to ambulate for 4 steps in the emergency department. Bone Scan Ankle Bone scan is not routinely used as the first imaging study for the evaluation of acute trauma to the ankle with positive OAR. talus, or calcaneus, OR CT Ankle Although CT may be used in polytrauma patients to determine the extent of injury in complex fractures, CT is not routinely used as the first imaging study of acute trauma to the ankle with positive OAR when exclusionary criteria do not apply.
Acute Trauma to the Ankle. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Acute Trauma to the Ankle possible cautionary or exclusionary scenarios include pregnancy, penetrating trauma, or presence of prior recent outside radiographs on transfer. Special Imaging Considerations Avoidance of manipulation of the ankle prior to radiographs in the absence of neurovascular deficit or critical skin injury is recommended in order to avoid remanipulation or complication in this setting [27]. Advances in MRI technology have facilitated short dedicated extremity MRI protocols in some centers that may be used as an emergent adjunct to radiographs [28]. OR Discussion of Procedures by Variant Variant 1: Adult or child 5 years of age or older. Acute trauma to the ankle or acute trauma to the ankle with persistent pain for more than 1 week but less than 3 weeks. No exclusionary criteria present. Initial imaging. Patient meets the requirements for evaluation by the Ottawa Ankle Rules which are positive: 1. Inability to bear weight immediately after the injury, OR 2. Point tenderness over the medial malleolus, the posterior edge or inferior tip of the lateral malleolus, 2. Point tenderness over the medial malleolus, the posterior edge or inferior tip of the lateral malleolus, talus, or calcaneus, OR 3. Inability to ambulate for 4 steps in the emergency department. Bone Scan Ankle Bone scan is not routinely used as the first imaging study for the evaluation of acute trauma to the ankle with positive OAR. talus, or calcaneus, OR CT Ankle Although CT may be used in polytrauma patients to determine the extent of injury in complex fractures, CT is not routinely used as the first imaging study of acute trauma to the ankle with positive OAR when exclusionary criteria do not apply.