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The original Ottawa Ankle Rules (OAR) excluded children under age 18 years. Two recent large prospective studies expanded the rules to include children as young as 1 year.
In one study, the originators of the OAR enrolled 670 children ages 2 to 16 years who presented within 48 hours of a foot or ankle injury. Clinically significant fractures were defined as fractures 3 mm or larger; Salter-Harris type 1 fractures were excluded. The other study enrolled 761 children, 1 to 15 years old, with ankle or midfoot injuries who presented to a children's hospital in England after implementation of the OAR. A group of 782 patients who presented before implementation served as historical controls.
In the Ottawa study, the OAR was found to be 100% sensiti…