Utility of Ottawa ankle rules in excluding ankle fractures in Indian scenario


  • Malay K. Mandal Department of Orthopedics, KPCMCH, Jadavpur, Kolkata, West Bengal, India
  • Anirban Paul Department of Orthopedics, KPCMCH, Jadavpur, Kolkata, West Bengal, India
  • Abhijit Sen Department of Orthopedics, KPCMCH, Jadavpur, Kolkata, West Bengal, India
  • S. Sariful Rahman Department of Orthopedics, KPCMCH, Jadavpur, Kolkata, West Bengal, India
  • Bimalendu Bikash Hazra Department of Orthopedics, KPCMCH, Jadavpur, Kolkata, West Bengal, India




OAR, Utility of OAR, Excluding ankle fractures, Application of OAR in Indian scenarios


Background: Patients with acute ankle injuries form a major bulk in outdoor and emergency room, and many of them get radiographs done to rule out fractures. Ottawa ankle rules (OAR) may reduce the need for unnecessary radiographs by detecting fractures only with help of simple clinical findings.  We conducted this study to see the extent of usefulness of these rules in our day-to-day practice.

Methods: Our study is observational in nature. A total of 107 patients who visited the clinic of the chief investigator between the time period from 1st January 2019 to 31st December 2020, fulfilling inclusion criteria and willing to participate, were enrolled. The patients were examined clinically, and the assessor recorded the findings on a previously prepared assessment form. Data analysis was done from the master chart.

Results: Among the 107 patients, 46 patients were ‘suspicion positive’ by OAR. After the radiographic assessment, we found 11 fractures, all of which belonged to the ‘suspicion positive’ group. Statistical analysis showed that OAR had a sensitivity of 100% for ankle fractures, whereas specificity for the same was 63.54%. We found the positive predictive value to be 23.91% and negative predictive value to be 100%, positive likelihood ratio of 2.74, and negative likelihood ratio of 0.

Conclusions: OAR is an easy and reliable tool to screen ankle fractures. In a country with as massive a health care burden as ours, it can reduce the number of unnecessary radiographs and thus reduce exposure, cost, and time of medical professionals.


Smith GF, Madlon-Kay DJ, Hunt V. Clinical evaluation of ankle inversion injuries in family practice offices. J Fam Pract. 1993;37(4):345-8.

Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992;21(4):384-90.

Sujitkumar P, Hadfield JM, Yates DW. Sprain or fracture? An analysis of 2000 ankle injuries. Arch Emerg Med. 1986;3(2):101-6.

Brooks SC, Potter BT, Rainey JB. Inversion injuries of the ankle: clinical assessment and radiographic review. Br Med J (Clin Res Ed). 1981;282(6264):607-8.

Cockshott WP, Jenkin JK, Pui M. Limiting the use of routine radiography for acute ankle injuries. Can Med Assoc J. 1983;129:129-31.

Singh S. Application of Ottawa Ankle Rules. Int Res J Med Sci. 2014;2(10):7-12.

Meena S, Gangari SK. Validation of the Ottawa Ankle Rules in Indian Scenario. Arch Trauma Res. 2015;4:2.

Wang X, Chang SM, Yu GR, Rao ZT. Clinical value of the Ottawa ankle rules for diagnosis of fractures in acute ankle injuries. PLoS One. 2013;8(4):e63228.

Bachmann LM, Kolb E, Koller MT, Steurer J, Ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417.






Original Research Articles