What is new since the Ottawa Ankle Rules (OAR)?
Ankle sprains are a common occurrence in both primary care as well as emergency departments. To determine whether an X-Ray should be implemented to exclude a fracture or not by the clinician was first elucidated under certain terms which are known as the Ottawa ankle rules (OAR), since 1992. However, from 2003 the use of systematic reviews as the basis for OAR was recommended by various guidelines.
The paper deals with the assessment of the most accurate method regarding the fracture risk associated with ankle sprains in adults to systematically review the current evidences. For the meta-analyses, systematic reviews and primary studies; an efficient search was performed in several databases like Pedro, CINAHL, Embase, Medion and specific guideline search engines. Selection, quality appraisal (with validated checklists) and data extraction was performed under two independent researchers. For this, one systematic review and 21 primary studies were considered for sensitivity and specificity of 92-100% and 16-51% drawn out from the OAR range. Bernese ankle rules are some of the other tools used for betterment of OAR specificity. OAR positive patients could rely on the vibrating tuning fork test and ultrasound to decline the use of radiographs. Although for the acute ankle sprains, no supporting proof was found for magnetic resonance imaging (MRI) or computed tomography (CT). These findings have paved way to other or new tools to lower the X-rays usage. Also, after an ankle sprain, the value of OAR at ruling out fractures have been confirmed.