Ankle



Remember analgesia.Always assess and record the patient's ability to bear weight


Ankle sprains - Ottawa Ankle Rules

Ottawa Ankle Rules

Ankle x-rays are required if only if criteria below are fulfilled.

  • With apparent ankle injuries, check other sites of trauma which are easily missed (i.e. tendo-achilles, os calcis, base of 5th metatarsal, whole of fibula (and tibia)
  • Remember to x-ray the foot if there is bony tenderness over the navicular or base of 5th metatarsal
  • Check for AP instability
  • Treat by ice (if recent), elevation and active exercises when elevated
  • Encourage weight bearing, [BestBets] give stick/crutches if necessary
  • In the case of a bad sprain, the above treatment is best supervised by direct referral to physiotherapy.

Malleolar fractures

  • If undisplaced, treat with below-knee POP and refer to the Fracture Clinic (CUH Fracture Clinic Referral form)
  • Consider prophylactic anticoagulation (LMWH) if high risk of VTE or prior DVT.[BestBets]
  • CUH EM and Orthpaedic divisions have (Feb 2013) reviewed the literature (including the 2012 Oct CEM guideline). Prophylactic anticoagualtion is not required those pateints discharged in a backslab
  • If displaced or tibio-fibular diastasis, refer to the on-call Orthopaedic Team
  • If diastasis, obtain X-ray of whole leg.

Tillaux #

  • SH 3 (saLtr) # distal tibia / tibiofibular lig
  • 12-14 yo, rotation / inversion injury (epihpysis matures from med to lat)
  • Swollen+, NWB, x-ray may be subtle
  • Check (clinical and x-ray) prox fibula in case of Maisonneuve # (peroneal nerve)
  • Often need ORIF (beware displacement >2mm)
Tillaux #
Maisonneuve #

Thromboprophylaxis

In patients immobilised in leg casts:

  • Consider prophylactic anticoagulation (LMWH) if high risk of VTE or prior DVT.[BestBets]
  • CUH EM and Orthpaedic divisions have (Feb 2013) reviewed the literature (including the 2012 Oct CEM guideline). Prophylactic anticoagualtion is not required those pateints discharged in a splint but should be considered in all in PoP


Content by Dr Íomhar O' Sullivan 14/03/2004.  Reviewed by Dr ÍOS 06/01/2005, 17/07/2005, Dr Chis Luke 17/07/2005, ÍOS 08/02/2007.Last review Dr ÍOS 15/10/21.