The Ottawa Ankle Rules (OAR) have been found to be 100% sensitive in adult patients with ankle injuries, and application of the OAR has resulted in a 28% reduction in the number of x-rays ordered. The objectives of this study were to determine the sensitivity and specificity of the OAR in children and to determine the potential change in x-ray utilization. […]

Radiographs are ordered routinely for children with ankle trauma. We assessed the predictive value of a clinical examination to identify a predefined group of low-risk injuries, management of which would not be affected by absence of a radiograph. We aimed to show that no more than 1% of children with low-risk examinations (signs restricted to the distal fibula) would have high-risk fractures (all fractures except avulsion, buckle, and non-displa […]

In skeletally immature children, it can often be difficult to differentiate occult Salter-Harris I fibula fractures from ankle sprains based on physical examination, and often, initial radiographs in both conditions are only notable for soft tissue swelling. The likelihood of a child having subsequent plain radiographic evidence of a fracture in this setting and the likelihood of subsequent fracture displacement have not been previously reported. […]

The Ottawa Ankle Rules, Low-Risk Exam, and Malleolar Zone Algorithm are assessment rules designed to minimize radiographs performed on children with ankle trauma. We aim to determine the criterion validity of the abovementioned 3 rules for predicting clinically important ankle fractures in children. […]

The Low Risk Ankle Rule (LRAR) is a validated clinical decision rule (CDR) about the indications for ankle radiographs in children with acute blunt ankle trauma. Although application of the LRAR has the potential to safely reduce the rate of ankle radiography by 60%, current x-ray rates in most emergency departments (EDs) in the United States and Canada remain unnecessarily high (85%-100%). To evaluate this gap between knowledge and practice, phy […]

The Low Risk Ankle Rule is a validated clinical decision rule that has the potential to safely reduce radiography in children with acute ankle injuries. We performed a phased implementation of the Low Risk Ankle Rule and evaluated its effectiveness in reducing the frequency of radiography in children with ankle injuries. […]

Randomized trials have shown that removable immobilization devices are at least as good as circumferential casts for the management of common specific types of pediatric wrist and ankle fractures. Our main objective was to determine the proportion of emergency physicians who prescribe removable devices for distal radius buckle fractures and/or nondisplaced distal fibular Salter-Harris I fractures. We also examined follow-up referral patterns for […]

LowRisk Ankle Rule (LRAR) has 100% sensitivity for identifying clinically important pediatric ankle fractures (high-risk injuries) and has the potential to safely reduce imaging by approximately 60%. This study investigates the safety and cost-effectiveness of this rule in our institution. […]

If even the magnificent Michael Jordan could have his “ankles broke” by Allen Iverson’s maleficent cross-over , then it should come as no surprise that mere mortal children will present to our EDs with ankle injuries. If the patients were adults, we’d feel comfortable applying the Ottawa Ankle Rules . The question, then, is whether we can apply any Clinical Decision Rules in a child presenting with an Ankle Injury .

Sean M. Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.