Orthopedic Assessment Tools

The Ottawa Ankle Rules are a clinical decision tool that determines whether ankle or midfoot X-rays are needed after an injury. They have a sensitivity of nearly 100% for significant fractures, meaning they almost never miss a fracture. Following these rules can safely reduce unnecessary ankle X-rays by 30–40%.

The Ottawa Knee Rules determine whether knee X-rays are needed after acute knee injury. X-rays are indicated if the patient is age ≥55, has isolated patellar tenderness, has fibular head tenderness, cannot flex the knee to 90°, or cannot bear weight for 4 steps. The rules have nearly 100% sensitivity for clinically significant fractures.

The Ottawa Ankle and Knee Rules were originally validated in adults. They can be applied to children over age 5–6 with caution, but clinical judgment should take precedence in pediatric patients. Growth plate injuries may not be captured by standard X-ray criteria.