Guideline summary · Musculoskeletal · 5 min read
Ottawa ankle and knee rules
Clinical decision rules that safely reduce unnecessary X-rays.
Key points
- Ankle X-ray: pain in the malleolar zone plus bone tenderness at the posterior edge or tip of either malleolus.
- Ankle X-ray also when the patient cannot bear weight for four steps, both immediately and in the department.
- Foot X-ray: midfoot pain plus tenderness at the base of the fifth metatarsal or the navicular, or inability to bear weight.
- Knee X-ray: age 55 or over, isolated patellar tenderness, fibular head tenderness, inability to flex to 90°, or inability to bear weight.
- The rules have sensitivity close to 100% for clinically important fractures in adults.
Ottawa ankle rules (derived 1992) and Ottawa knee rule (1995); validated in many later studies. A study aid, not a substitute for the current guideline or local protocols.
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