by James Hubbard, M.D., M.P.H.

I still remember when a sweet, smiling little girl came into my office a few years back. She had injured her wrist. I did my usual exam which includes palpating areas of tenderness. Well I hit a sore spot; she let out a yelp and sobbed “why did you hurt me?” I felt so bad, but was tempted to tell her that’s what doctors do (not really). Instead I explained I needed to know what specific area was injured so I would know where to look on an x-ray. I don’t think she bought it.

At any rate, I thought of this when I read an Academy of Emergency Medicine study concluded the Ottawa Ankle Rules could be applied to as young as 6 years old and up. What are these rules?

They are simple guidelines to help a doctor determine whether an injured ankle or foot should be x-rayed. Of course judgment and type of injury is always considered, but these rules are about 95 percent accurate. They were set up to try to cut down on needless x-rays.

An ankle should be x-rayed if:

1. There is inability to bear weight.
2. There is tenderness anywhere along the last 6 cm (about 2.5 inches) of the tibia (inside shin bone) or the fibula (outside smaller leg bone).

A foot should be x-rayed if:

1. There is inability to bear weight.
2. There is tenderness along the end of the fifth metatarsal (a little area that juts out on the outside of your foot an inch or so from the tip of the fibula) or tenderness around the top, inside of the foot.

To me that just means if you find a tender spot, x-ray it. Emergency clinicians may be able to discern it better since they see more injuries.

Certainly the Ottawa rules are not perfect and fractures can be missed. I saw one guy who had been walking on his broken leg for weeks before he came in. On the other side of the coin, a fracture may not show up on x-ray immediately, so be sure to follow up a week or so afterwards if the pain continues.

By the way, a crack or break is all the same to doctors. Both are considered fractures.

Full disclosure: My youngest daughter fell off her bike when she was little. She hurt her wrist but I couldn’t find an area of tenderness (she’s tough). The next day she was still hurting. An x-ray revealed a fracture. Of course medically it didn’t hurt to wait, but I know I felt more horrible than she. I can commiserate when I see a child whose mother has done the same.

Are there any more of us out there?

Tags: children, injuries

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This entry's content reflects the opinions and reporting of the author and not necessarily that of JHMFD. This entry was posted on Wednesday, April 22nd, 2009 at 12:01 am and is filed under Children's Health, Emergency Care, Studies. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.