Department of Orthopedics, Tongji Hospital of Tongji University, School of Medicine, Shanghai, China.
PLoS One. 2013 Apr 30;8(4):e63228. doi: 10.1371/journal.pone.0063228. Print 2013.
The Ottawa ankle rules (OAR) are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The OAR have been proven that their application reduces unnecessary radiography. They have nearly perfect sensitivity for identifying clinically significant ankle fractures.
The purpose of this study was to assess the applicability of the OAR in China, to examine their accuracy for the diagnosis of fractures in patients with acute ankle sprains, and to assess their clinical utility for the detection of occult fractures.
In this prospective study, patients with acute ankle injuries were enrolled during a 6-month period. The eligible patients were examined by emergency orthopedic specialists using the OAR, and then underwent ankle radiography. The results of examination using the OAR were compared with the radiographic results to assess the accuracy of the OAR for ankle fractures. Patients with OAR results highly suggestive of fracture, but no evidence of a fracture on radiographs, were advised to undergo 3-dimensional computed tomography (3D-CT).
183 patients with ankle injuries were enrolled in the study and 63 of these injuries involved fractures. The pooled sensitivity, specificity, positive predictive value and negative predictive value of the OAR for detection of fractures of the ankle were 96.8%, 45.8%, 48.4% and 96.5%, respectively. Our results suggest that clinical application of the OAR could decrease unnecessary radiographs by 31.1%. Of the 21 patients with positive OAR results and negative radiographic findings who underwent 3D-CT examination, five had occult fractures of the lateral malleolus.
The OAR are applicable in the Chinese population, and have high sensitivity and modest specificity for the diagnosis of fractures associated with acute ankle injury. They may detect some occult fractures of the malleoli that are not visible on radiographs.
渥太华踝关节规则（OAR）是用于确定踝关节损伤患者是否需要接受射线照相检查的临床决策指南。OAR 已被证明可以减少不必要的射线照相检查。它们对识别临床上有意义的踝关节骨折具有近乎完美的敏感性。
本研究旨在评估 OAR 在我国的适用性，检验其对急性踝关节扭伤患者骨折诊断的准确性，并评估其对隐匿性骨折检测的临床应用价值。
在这项前瞻性研究中，在 6 个月期间纳入急性踝关节损伤患者。合格的患者由急诊骨科专家使用 OAR 进行检查，然后进行踝关节射线照相。将 OAR 检查结果与射线照相结果进行比较，以评估 OAR 对踝关节骨折的准确性。OAR 结果高度提示骨折，但射线照相未见骨折的患者，建议进行三维计算机断层扫描（3D-CT）。
共纳入 183 例踝关节损伤患者，其中 63 例涉及骨折。OAR 对踝关节骨折的检测的敏感性、特异性、阳性预测值和阴性预测值的合并值分别为 96.8%、45.8%、48.4%和 96.5%。我们的结果表明，临床应用 OAR 可以减少 31.1%的不必要射线照相检查。在 21 例 OAR 阳性且射线照相阴性的患者中，有 5 例接受了 3D-CT 检查，发现有外踝隐匿性骨折。
OAR 适用于中国人群，对急性踝关节损伤相关骨折的诊断具有高敏感性和适度特异性。它们可能会检测到一些在射线照相上不可见的外踝隐匿性骨折。
