Validation of Ottawa ankle rules protocol in Greek athletes: study in the emergency departments of a district general hospital and a sports injuries clinic

E Papacostas¹, N Malliaropoulos⁴, A Papadopoulos² and C Liouliakis³

¹ Department of Orthopaedics, Xanthi District General Hospital, Greece
² Department of Orthopaedics, Katerini District General Hospital, Greece
³ Department of Radiology, Katerini District General Hospital
⁴ Athletics Federation Sports Medicine Centre, Thessaloniki, Greece

Correspondence to:
Dr Papacostas, Department of Orthopaedics, Xanthi General Hospital, 67100 Xanthi, Greece papman{at}aias.gr

Objective—To validate the Ottawa ankle rules protocol for predicting ankle and midfoot fractures in Greek athletes.

Method—A prospective survey in the emergency departments of a district general hospital and a sports injury clinic in Greece over nine months. A clinical evaluation was made of 122 patients with acute ankle and/or midfoot injury, and then radiographs were taken.

Results—Nine ankle and eight midfoot fractures were detected. The sensitivity of the Ottawa ankle rules protocol in predicting fractures in both the malleolar and midfoot zones was 100%. The negative predictive value for each of these areas was also 1.0. Specificity was estimated to be 0.3 for ankle fractures and 0.4 for midfoot fractures. Positive predictive values were 0.16 and 0.28 respectively. A possible reduction of up to 28.7% was found in the need for radiography.

Conclusions—Use of the Ottawa ankle rules protocol in evaluating injured Greek athletes resulted in 100% sensitivity when performed by orthopaedic residents or sports medicine doctors, and had the potential to reduce the use of radiography.

Key Words: ankle sprains; radiographs; injuries

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• Bachmann, L. M, Kolb, E., Koller, M. T, Steurer, J., ter Riet, G. (2003). Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 326: 417-417 [Abstract] [Full Text]