OnExam

Used to determine whether or not x-rays are needed for patients with ankle pain. Note that they are not applicable to patients under the age of 18.

Assessing the Patient

  1. An ankle x-ray series is indicated if there is:
    • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus OR
    • Bone tenderness along the distal 6 cm of the posterior edge of the fibular or tip of the lateral malleolus OR
    • Inability to bear weight and walk four steps both immediately and in the ED
  2. A foot x-ray series is indicated if there is any pain in the midfoot and:
    • Bone tenderness over base of the fifth metatarsal OR
    • Bone tenderness over navicular bone OR
    • Inability to bear weight and walk four steps both immediately and in the ED
    • Sensitivity: 98%, Specificity: 32%
    • LR+ = 1.4, LR- = 0.07

References

  1. Pawa J, Lesniak, D., & Lott, A. Approach to the OSCE: The Edmonton Manual of Common Clinical Scenarios. Edmonton Manual; 2011.
  2. Baxter S, ed., McScheffrey G, ed. Toronto Notes: Comprehensive Medical Reference & Review for MCCQE 1 & USMLE 2. 26th ed. Toronto: Toronto Notes for Medical Students Inc; 2010.
  3. Filate W, Leung R, Ng D, Sinyor M, eds. Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto, 2005.
  4. Hurley K. OSCE and Clinical Skills Handbook. Halifax: Elsevier Canada; 2005.