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Evaluating fracture risk in acute ankle sprains: any news since the Ottawa Ankle Rules?: a systematic review

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Abstract
Background: Ankle sprain is frequently encountered, both in primary care and in emergency departments. Since 1992, the Ottawa ankle rules (OAR) can assist clinicians in determining whether an X-ray should be performed to exclude a fracture. Several guidelines recommend the use of OAR based on a systematic review from 2003. Ten years later, one can wonder if this recommendation should be changed. Objective: To review systematically the current evidence on the most accurate method to assess the fracture risk after an ankle sprain in adults. Methods: A methodical search for systematic reviews, meta-analyses and primary studies was carried out in Medline, Cochrane Database of systematic reviews, Embase, Pedro, CINAHL, Medion and specific guideline search engines. At least two independent researchers performed selection, quality appraisal (with validated checklists) and data extraction. Results: One systematic review and 21 primary studies were selected. Sensitivity and specificity of the OAR range from 92-100% and from 16-51%, respectively. To improve the OAR specificity, other tools are proposed such as the Bernese ankle rules. Vibrating tuning fork test and ultrasound could be useful in patient with OAR positive to decrease the need for radiographs. No evidence was found in favour of the use of magnetic resonance imaging (MRI) or computed tomography (CT) in the acute phase of ankle sprain. Conclusion: The findings confirm the value of the OAR at ruling out fractures after an ankle sprain and propose other or additional tools to decrease the need for X-rays.
Keywords
diagnosis, VALIDATION, systematic review, primary care, general practice, Ankle injuries, SPECIALIZED EMERGENCY NURSES, DIAGNOSTIC DECISION RULES, STRESS RADIOGRAPHY, FOOT, INJURIES, TRAUMA, POPULATION, ACCURACY

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Chicago
Jonckheer, Pascale, Tine Willems, Roel De Ridder, Dominique Paulus, Kirsten Holdt Henningsen, Lorena San Miguel, An De Sutter, and Philip Roosen. 2016. “Evaluating Fracture Risk in Acute Ankle Sprains: Any News Since the Ottawa Ankle Rules?: a Systematic Review.” European Journal of General Practice 22 (1): 31–41.
APA
Jonckheer, P., Willems, T., De Ridder, R., Paulus, D., Holdt Henningsen, K., San Miguel, L., De Sutter, A., et al. (2016). Evaluating fracture risk in acute ankle sprains: any news since the Ottawa Ankle Rules?: a systematic review. EUROPEAN JOURNAL OF GENERAL PRACTICE, 22(1), 31–41.
Vancouver
1.
Jonckheer P, Willems T, De Ridder R, Paulus D, Holdt Henningsen K, San Miguel L, et al. Evaluating fracture risk in acute ankle sprains: any news since the Ottawa Ankle Rules?: a systematic review. EUROPEAN JOURNAL OF GENERAL PRACTICE. 2016;22(1):31–41.
MLA
Jonckheer, Pascale, Tine Willems, Roel De Ridder, et al. “Evaluating Fracture Risk in Acute Ankle Sprains: Any News Since the Ottawa Ankle Rules?: a Systematic Review.” EUROPEAN JOURNAL OF GENERAL PRACTICE 22.1 (2016): 31–41. Print.
@article{7043272,
  abstract     = {Background: Ankle sprain is frequently encountered, both in primary care and in emergency departments. Since 1992, the Ottawa ankle rules (OAR) can assist clinicians in determining whether an X-ray should be performed to exclude a fracture. Several guidelines recommend the use of OAR based on a systematic review from 2003. Ten years later, one can wonder if this recommendation should be changed.
Objective: To review systematically the current evidence on the most accurate method to assess the fracture risk after an ankle sprain in adults.
Methods: A methodical search for systematic reviews, meta-analyses and primary studies was carried out in Medline, Cochrane Database of systematic reviews, Embase, Pedro, CINAHL, Medion and specific guideline search engines. At least two independent researchers performed selection, quality appraisal (with validated checklists) and data extraction.
Results: One systematic review and 21 primary studies were selected. Sensitivity and specificity of the OAR range from 92-100\% and from 16-51\%, respectively. To improve the OAR specificity, other tools are proposed such as the Bernese ankle rules. Vibrating tuning fork test and ultrasound could be useful in patient with OAR positive to decrease the need for radiographs. No evidence was found in favour of the use of magnetic resonance imaging (MRI) or computed tomography (CT) in the acute phase of ankle sprain.
Conclusion: The findings confirm the value of the OAR at ruling out fractures after an ankle sprain and propose other or additional tools to decrease the need for X-rays.},
  author       = {Jonckheer, Pascale and Willems, Tine and De Ridder, Roel and Paulus, Dominique and Holdt Henningsen, Kirsten and San Miguel, Lorena and De Sutter, An and Roosen, Philip},
  issn         = {1381-4788},
  journal      = {EUROPEAN JOURNAL OF GENERAL PRACTICE},
  keyword      = {diagnosis,VALIDATION,systematic review,primary care,general practice,Ankle injuries,SPECIALIZED EMERGENCY NURSES,DIAGNOSTIC DECISION RULES,STRESS RADIOGRAPHY,FOOT,INJURIES,TRAUMA,POPULATION,ACCURACY},
  language     = {eng},
  number       = {1},
  pages        = {31--41},
  title        = {Evaluating fracture risk in acute ankle sprains: any news since the Ottawa Ankle Rules?: a systematic review},
  url          = {http://dx.doi.org/10.3109/13814788.2015.1102881},
  volume       = {22},
  year         = {2016},
}

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