Ottawa ankle rules: Patients with ligamentous injury need better  treatment in Britain

doi:10.1136/bmj.326.7399.1147-b

BMJ 2003;326:1147 (24 May), doi:10.1136/bmj.326.7399.1147-b

Letter

Ottawa ankle rules

Patients with ligamentous injury need better treatment in Britain

The first 150 words of the full text of this article appear below.

EDITOR—In his editorial supporting the use of the Ottawa rules, Heyworth suggests that injured ankles be separated intotwo groups: those with simple ligamentous injury to soft tissueor a small avulsion fracture and those with more serious fracturesrequiring immobilisation.¹ This unfortunately reflects thecasual treatment given to patients with ligamentous ankle sprainsin British accident and emergency departments. Up to a thirdof patients with an ankle sprain may develop disabling problemssuch as recurrent instability or chronic pain.

Doctors and nurses should be aware that the Ottawa rules aresimply guidelines to decide which group of patients shouldhave radiography. Patients with severe ankle sprains—forexample, those who cannot bear weight—need more thana compression bandage and advice on ice and elevation: theyalso need protection in an ankle stirrup or cast, and they should be referred for physiotherapy for stretching, strengthening,balance, and return . . . [Full text of this article]

Dishan Singh, consultant orthopaedic surgeon

Royal National Orthopaedic Hospital, Foot and Ankle Unit, Stanmore, Middlesex HA7 4LB dishansingh@aol.com