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The Ottawa ankle rules serve as a prototype for developing, testing, and implementing guidelines that substantially decrease the use of unnecessary x-rays while identifying the vast majority of significant ankle fractures. This British study evaluated the Ottawa rules in an accident and emergency department at a teaching institution.
Rather than test the rules overtly, the authors added a checklist of 12 items to the required charting of patients presenting with ankle injuries; only four of these items were part of the Ottawa rules. Other than the checklist, physicians were unaware of the nature of the study and were told not to alter their usual practice. The charts of 800 patients treated over five months were then reviewed. Radiography wa…