A 20-year perspective on the Ottawa Ankle Rules: Are We Still on Solid Footing?

ABSTRACT Originally begun in 1992, Dr. Ian Stiell and colleagues first published a series of four manuscripts detailing a clinical decision rule for the use of radiographs in traumatic ankle and foot injuries.Finalized in 1995, these four publications collectively detailed the studies that enrolled 17,354 subjects and the specific history and physical examination to be utilized to ascertain if radiographs were necessary, or, could be deferred while capturing 100% of clinically significant fractures. Clinically insignificant ankle fractures are commonly defined as distal fibular or malleolar chip-fractures of 3 mm or less. This protocol was named the Ottawa Ankle Rules (OARs). Stiell, et al. concluded that that at least one-third of all ankle and foot radiographs could be eliminated by utilizing what colloquially became their “rules.” These have been widely adopted as the standard of care in emergency departments and we now have more than 20-years of experience utilizing this protocol. Are these rules still valid, should they still be utilized, or, alternatively, should the OARs be displaced by a superior protocol