8 The OAR have demonstrated sensitivities of 95-100% for detecting medial and lateral malleolar fractures. 6, 7 A modification called the Buffalo Ankle Rules found that tenderness to palpation of the mid body of the malleoli (palpating 6 cm proximally) was slightly more specific and equally sensitive. 6, 7 The rules apply to any individual presenting to the emergency room or for medical care after a traumatic activity with tenderness to palpation of the posterior edge or tip of either malleoli (palpating 6 cm proximally) and/or inability to fully weight bear at least 4 steps. The Ottawa Ankle Rules (OAR) were developed to decrease cost of ordering extraneous radiographs while reducing the risk of missing fractures of the ankle or foot. 5 With the increase of direct access in many health care facilities, it is paramount that clinicians recognize the need to obtain necessary radiographic images either via radiographic request or appropriate physician referral to correctly diagnose potential fractures of the ankle and ultimately provide proper care. 3, 4 While sprains are certainly the most common injury to the ankle, ankle fractures are frequently seen in emergency rooms with an incidence of 1- persons per year. 1, 2 Depending on the activity, a large amount of force can be imparted across the ankle joint, leading to fracture and/or ligament disruption. Among these athletes, the ankle is the most commonly reported site of injury each year. ![]() These activities often result in similar injuries as those sustained by high school and college athletes. ![]() United States Military Cadets are a unique group of college-aged individuals who are required to perform high level athletic and physical activities on a regular basis.
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