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
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
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
Pawa J, Lesniak, D., & Lott, A. Approach to the OSCE: The Edmonton Manual of Common Clinical Scenarios. Edmonton Manual; 2011.
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.
Filate W, Leung R, Ng D, Sinyor M, eds. Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto, 2005.
Hurley K. OSCE and Clinical Skills Handbook. Halifax: Elsevier Canada; 2005.