When to Xray lower limb injuries

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When to X-ray lower limb injuries?

• Dr Simon Binks
• SpR Emergency Medicine

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Football Player
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Netball Player
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Netball Player - following day
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Spot the fracture!

• Mechanism
• Degree of pain
• Degree of bruising
• Non-weight bearing
• Bony tenderness

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Ottawa Ankle Rules
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(No Transcript)
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Meta-analysis

• Meta-analysis
• 27 studies reporting on 15 581
• Missed 47 fractures
• Sensitivity 99.7
• Specificity about 35
• Accuracy of Ottawa ankle rules Bachmann L, BMJ
  326 FEB 03

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Fall onto off bike
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Ottawa knee rules

• X-ray required for knee injury patients if -
• age 55 or over
• isolated tenderness of the patella (no bone
  tenderness of the knee other than the patella)
• tenderness at the head of the fibula
• inability to flex to 90 degrees
• inability to weight bear both immediately and in
  ED (4 steps - unable to transfer weight twice
  onto each lower limb regardless of limping).

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Ottawa knee rules
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Controlled clinical trial

• EDs - 2 teaching 2 community hospitals.
• 3907 consecutive eligible adults
• Acute knee injuries during two 12-month periods
  before and after the intervention.
• 26.4 Reduction in X-ray requests
• 100 sensitivity
• Implementation Ottawa Knee Rule IG Stiell JAMA
  1997 2782075-9