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At least 595 records · Page 33Linked to original sources
PubMed2005

Estimation of passive ankle joint moment during standing and walking.

This study estimated the passive ankle joint moment during standing and walking initiation and its contribution to total ankle joint moment during that time. The decrement of passive joint moment due to muscle fascicle shortening upon contraction was taken into account. Muscle fascicle length in the medial gastrocnemius, which was assumed to represent muscle fascicle length in plantarflexors, was measured using ultrasonography during standing, walking initiation, and cyclical slow passive ankle joint motion. Total ankle joint moment during standing and walking initiation was calculated from ground reaction forces and joint kinematics. Passive ankle joint moment during the cyclical ankle joint motion was measured via a dynamometer. Passive ankle joint moment during standing and at the time (Tp) when the MG muscle-tendon complex length was longest in the stance phase during walking initiation were 2.3 and 5.4 Nm, respectively. The muscle fascicle shortened by 2.9 mm during standing compared with the length at rest, which decreased the contribution of passive joint moment from 19.9% to 17.4%. The muscle fascicle shortened by 4.3 mm at Tp compared with the length at rest, which decreased the contribution of passive joint moment from 8.0% to 5.8%. These findings suggest that (a) passive ankle joint moment plays an important role during standing and walking initiation even in view of the decrement of passive joint moment due to muscle fascicle shortening upon muscle contraction, and (b) muscle fascicle shortening upon muscle contraction must be taken into account when estimating passive joint moment during movements.

Adult↗
PubMed2004

Correlation and sex differences between ankle and knee cartilage morphology determined by quantitative magnetic resonance imaging.

OBJECTIVE: To study the correlation between ankle and knee cartilage morphology to test the hypothesis that knee joint cartilage loss in gonarthritis can be estimated retrospectively using quantitative MRI analysis of the knee and ankle and established regression equations; and to test the hypothesis that sex differences in joint surface area are larger in the knee than the ankle, which may explain the greater incidence of knee osteoarthritis in elderly women than in elderly men. METHODS: Sagittal MR images (3D FLASH WE) of the knee and hind foot were acquired in 29 healthy subjects (14 women, 15 men; mean (SD) age, 25 (3) years), with no signs joint disease. Cartilage volume, thickness, and joint surface area were determined in the knee, ankle, and subtalar joint. RESULTS: Knee cartilage volumes and joint surface areas showed only moderate correlations with those of the ankle and subtalar joint (r = 0.33 to 0.81). The correlations of cartilage thickness between the two joints were weaker still (r = -0.05 to 0.53). Sex differences in cartilage morphology at the knee and the ankle were similar, with surface areas being -17.5% to -23.5% lower in women than in men. CONCLUSIONS: Only moderate correlations in cartilage morphology of healthy subjects were found between knee and ankle. It is therefore impractical to estimate knee joint cartilage loss a posteriori in cross sectional studies by measuring the hind foot and then applying a scaling factor. Sex differences in cartilage morphology do not explain differences in osteoarthritis incidence between men and women in the knee and ankle.

Adult↗
PubMed2003

The Football Association Medical Research Programme: an audit of injuries in professional football: an analysis of ankle sprains.

AIM: To conduct a detailed analysis of ankle sprains sustained in English professional football over two competitive seasons. METHODS: Club medical staff at 91 professional football clubs annotated player injuries. A specific injury audit questionnaire was used together with a weekly form that documented each club's current injury status. RESULTS: Completed injury records for the two competitive seasons were obtained from 87% and 76% of the participating clubs. Ankle ligament sprains accounted for 11% of the total injuries over the two seasons, with over three quarters (77%) of sprains involving the lateral ligament complex. A total of 12 138 days and 2033 matches were missed because of ankle sprains. More sprains were caused by contact mechanisms than non-contact mechanisms (59% v 39%) except in goalkeepers who sustained more non-contact sprains (21% v 79%, p<0.01). Ankle sprains were most often observed during tackles (54%). More ankle sprains were sustained in matches than in training (66% v 33%), with nearly half (48%) observed during the last third of each half of matches. A total of 44% of sprains occurred during the first three months of the season. A high number of players (32%) who sustained ankle sprains were wearing some form of external support. The recurrence rate for ankle sprains was 9% (see methodology for definition of reinjury). CONCLUSION: Ankle ligament sprains are common in football usually involving the lateral ligament complex. The high rate of occurrence and recurrence indicates that prevention is of paramount importance.

Adolescent↗
PubMed2004

Cartilage thickness in cadaveric ankles: measurement with double-contrast multi-detector row CT arthrography versus MR imaging.

PURPOSE: To test the accuracy of double-contrast multi-detector row computed tomographic (CT) arthrography for measurement of cartilage thickness in cadaveric ankles and to compare this technique with three-dimensional (3D) fat-suppressed spoiled gradient-echo in the steady state (FS-SPGR) magnetic resonance (MR) imaging. MATERIALS AND METHODS: Five cadaveric ankles were used. In the ankle specimens, five to nine 1.5-mm-diameter holes were drilled across the joint traversing the tibial subchondral bone, tibial articular cartilage, talar dome cartilage, and talar subchondral bone. The ankle specimens were obtained and used according to institutional policies. Each ankle specimen was imaged first by using 3D FS-SPGR MR imaging with a 1.5-T magnet and then by using double-contrast arthrography followed by CT with a four-detector row scanner (ie, double-contrast multi-detector row CT arthrography). The section thickness used for CT scanning was 1.0 mm reconstructed in 0.5-mm intervals. The MR and CT images obtained in the five specimens were then downloaded to a workstation, where a measurement tool was used to measure the cartilage thickness at each hole. The physical measurement of cartilage thickness at each hole was used as the reference standard with which the MR imaging and CT measurements were compared. Linear regression and correlation analyses were performed by using a statistical computer program. RESULTS: Double-contrast arthrography followed by multi-detector row CT, as compared with 3D FS-SPGR MR imaging, enabled more accurate measurement of the physical cartilage thickness in the ankle (P < .001). CONCLUSION: In this study of five cadaveric ankles, multi-detector row CT arthrography was more accurate than 3D FS-SPGR MR imaging for measurement of articular cartilage thickness in the ankle.

Adult↗
PubMed1995

Synovial fluid in the hindfoot and ankle: detection of amount and distribution with US.

PURPOSE: To determine the amount and distribution of synovial fluid detectable with ultrasonography (US) of the hindfoot and ankle in asymptomatic volunteers. MATERIALS AND METHODS: US was performed with a 7.5- or 10-MHz linear transducer of 60 hindfeet and ankles in 30 volunteers. Presence and amount of fluid were assessed in the ankle joint recesses, adjacent bursae, and tendon sheaths. Symmetry of bilateral fluid was evaluated. RESULTS: Fluid was detected in the anterior recess in 20 ankles (bilaterally in eight volunteers), retrocalcaneal bursa in 30 ankles (bilaterally in 12 volunteers), posterior tibial tendon sheath in 46 ankles (bilaterally in 19 volunteers), and common peroneal tendon sheath in seven ankles (bilaterally in three volunteers). No fluid was seen in the posterior recess. On average, symmetry was present for only the retrocalcaneal bursal and peroneal tendon sheath fluid. CONCLUSION: US of the hindfoot and ankle commonly depicts articular, bursal, and tendon sheath fluid in asymptomatic volunteers. The presence of fluid in these locations, even when unilateral or asymmetric, does not necessarily imply underlying abnormality.

Adult↗
PubMed1998

Anterolateral impingement of the ankle: effectiveness of MR imaging.

PURPOSE: To determine the effectiveness of magnetic resonance (MR) imaging in the diagnosis of anterolateral impingement of the ankle. MATERIALS AND METHODS: MR images were reviewed in 12 patients (12 ankles) with arthroscopically proved anterolateral impingement and in 19 control subjects (20 ankles) with diagnoses other than impingement. MR images were scored by means of consensus of two musculoskeletal radiologists and independently by a third radiologist. Patients underwent imaging at 1.5 T, with use of standard imaging sequences and a dedicated extremity coil. RESULTS: For the consensus reading, the sensitivity, specificity, and accuracy of MR imaging for the diagnosis of impingement were 42%, 85%, and 69%, respectively. The frequency of lateral gutter fullness and anterior talofibular ligament thickening on MR images was higher in the 12 ankles with impingement (seven [58%] and seven [58%] ankles, respectively) than in the 20 control ankles (seven [35%] and five [25%] ankles, respectively), but these trends did not reach statistical significance. Interobserver agreement for anterior talofibular ligament thickening was high, whereas that for lateral gutter fullness was fair. CONCLUSION: Conventional MR imaging of the ankle is insensitive for anterolateral impingement. Anterior talofibular ligament thickening and soft-tissue fullness in the lateral gutter may be suggestive of the diagnosis, but the reliability of the latter finding is questionable.

Adult↗
PubMed2003

Toe pressure measurements compared to ankle artery pressure measurements.

The Trans-Atlantic Inter-Society Consensus (TASC)-recommended absolute toe pressure is < 30-50 mm Hg for definition of chronic critical limb ischemia (CLI). Toe pressures can be measured by different techniques. The authors analyzed the clinical use of the Doppler technique and an automatic device with optical sensors and estimated their value in documentation of chronic critical limb ischemia compared to ankle artery pressures. Three different investigations were performed: (1) In 16 healthy subjects the digital artery pressures were measured by using 3 different optical sensors (transmission, reflection, and microcirculation sensor) and compared to the systolic brachial pressure. (2) In 50 patients with and without peripheral arterial occlusive disease the toe pressures at digits 1 and 2 of both feet were determined by Doppler technique (8 MHz) and by optical sensors (cuff width constant 1.5 cm) and were compared to the ankle artery pressure determined by Doppler technique. (3) In 175 patients the toe pressures were measured at 1 toe and the ankle artery pressures were determined. In this group they estimated the clinical use of the toe pressure in regard to the definition of CLI (toe pressure < 50 mm Hg) compared to the ankle pressure < 70 mm Hg. The digital artery pressures measured with the different optical sensors, and the systolic brachial pressures were not significantly different and the correlation coefficients were around 0.7. In 21 of 50 patients the toe pressure at D1 and D2 could not be measured by Doppler technique because with the applied cuff no Doppler signal could be detected at the tip of the toe, but in 24 of these 29 patients the optical measurement was possible. Mean toe pressures at D1 were 108 +/- 45 mm Hg and D2 102 +/- 45 mm Hg, which were statistically not different. The correlation coefficient for the highest ankle artery pressure and the highest toe pressure determined by the Doppler technique was 0.389; for the highest ankle artery pressure and the toe pressure measured by the optical sensors it was 0.369, and for the toe pressures measured by Doppler technique and the optical sensors it was 0.506. Defining systolic ankle artery pressure < or = 50 to 70 mm Hg as the golden standard for CLI, the sensitivity of optical toe pressure measurement for the detection of CLI was 8%, the specificity was 96%, the positive predictive value 12%, and the negative predictive value was 94%. Independent of technique the absolute systolic toe pressures did not correlate with the absolute systolic ankle pressures. The optical measurement was more suitable for toe pressure measurement because it could be used in 90% of all patients. All in all, toe pressure measurements are more useful to exclude CLI than to prove it.

Adult↗
PubMedDate not supplied

Medial ankle instability: an exploratory, prospective study of fifty-two cases.

BACKGROUND: Very little objective data are available regarding medial ankle instability. HYPOTHESIS: Several structures contribute to the stabilization of the medial ankle, and, in the case of injury, they are not involved in a uniform way. STUDY DESIGN: Explorative, prospective case series. METHODS: Fifty-one patients (52 ankles; males 27, females 25; age 36.4 [16 to 60] years) were surgically treated because of medial ankle instability. All clinical findings and structural changes, as found by arthroscopy and surgical exploration, were compared with the clinical diagnosis and then addressed for surgical reconstruction. RESULTS: Pain in the medial gutter was noted in all ankles (100%). Arthroscopy verified a clinically expected additional lateral instability in 40 ankles (77%). At 4.43 years (2 to 6.5 years) after surgical reconstruction, the clinical result was considered to be good/excellent in 46 cases (90%), fair in 4 cases (8%), and poor in 1 case (2%). CONCLUSION: The clinical characteristics of medial ankle instability are a feeling of giving way, pain on the medial gutter of the ankle, and a valgus and pronation deformity of the foot that can typically be actively corrected by the posterior tibial muscle. Arthroscopy was shown to be a very helpful diagnostic tool in verifying medial instability.

Adolescent↗
PubMedDate not supplied

Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon.

PURPOSE: To study the effects of early weightbearing and ankle mobilization after acute repair of ruptured Achilles tendon. STUDY DESIGN: Comparative longitudinal study. METHODS: Patients in group 1 were postoperatively immobilized with their ankle in gravity equinus, they were encouraged to bear weight on the operated limb as soon as possible to full weightbearing, and they received a single cast change at 2 weeks, with the ankle accommodated in an anterior splint in a plantigrade position, allowing the ankle to be plantar flexed fully but not dorsiflexed above neutral. Patients in group 2 were immobilized with their ankle in full equinus with a cast change at 2 weeks, when the ankle was immobilized in mid equinus, and at 4 weeks, when the ankle was immobilized in a plantigrade position, and they were advised to bear weight. RESULTS: Patients in group 1 attended fewer outpatient visits, completely discarded their crutches at an average of 2.5 weeks, and more were satisfied with the results of surgery. At ultrasonography, the average thickness of the repaired tendon was 12.1 mm, with no difference in the thickness of the ruptured tendon regardless of postoperative management. There was no significant difference in isometric strength between the two groups. CONCLUSIONS: Early weightbearing with the ankle plantigrade is not detrimental to the outcome of repair after acute rupture of the Achilles tendon and shortens the time needed for rehabilitation. However, strength deficit and muscle atrophy are not prevented.

Achilles Tendon↗
PubMed2005

Intrinsic risk factors for inversion ankle sprains in male subjects: a prospective study.

BACKGROUND: Many variables have been retrospectively associated with ankle sprains. However, very little is known about factors predisposing people to these injuries. HYPOTHESIS: Measurable intrinsic factors might predispose male athletes to ankle sprains. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 241 male physical education students were evaluated for possible intrinsic risk factors for inversion sprains at the beginning of their academic study. The evaluated intrinsic risk factors included anthropometrical characteristics, functional motor performances, ankle joint position sense, isokinetic ankle muscle strength, lower leg alignment characteristics, postural control, and muscle reaction time during a sudden inversion perturbation. Subjects were followed prospectively for 1 to 3 years. RESULTS: A total of 44 (18%) of the 241 male subjects sustained an inversion sprain; 4 sprained both ankles. Cox regression analysis revealed that male subjects with slower running speed, less cardiorespiratory endurance, less balance, decreased dorsiflexion muscle strength, decreased dorsiflexion range of motion, less coordination, and faster reaction of the tibialis anterior and gastrocnemius muscles are at greater risk of ankle sprains. CONCLUSION: Based on our findings, it is suggested that running speed, cardiorespiratory endurance, balance, dorsiflexion strength, coordination, muscle reaction, and dorsiflexion range of motion at the ankle are associated with the risk of ankle inversion sprains in male subjects.

Adolescent↗
PubMed2005

Arthroscopic assessment for intra-articular disorders in residual ankle disability after sprain.

BACKGROUND: After ankle sprain, there can be many causes of disability, the origins of which cannot be determined using standard diagnostic tools. HYPOTHESIS: Ankle arthroscopy is a useful tool in identifying intra-articular disorders of the talocrural joint in cases of residual ankle disability after sprain. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: The authors gathered the independent diagnostic results of physical examination, standard mortise and lateral radiography, stress radiography of the talocrural joint, and magnetic resonance imaging for 72 patients with residual ankle disability lasting more than 2 months after injury (mean, 7 months after injury). They performed arthroscopic procedures and compared the double-blind results. RESULTS: In all cases, the arthroscopic results matched those of other means of diagnosis. In 14 cases, the arthroscopic approach exceeded the capabilities of the other methods. Including duplications, 39 patients (54.2%) had anterior talofibular ligament injuries, 17 patients (23.6%) had distal tibiofibular ligament injuries, 29 patients (40.3%) had osteochondral lesions, 13 patients (18%) had symptomatic os subfibulare, 3 patients (4.2%) had anterior impingement exostosis, and 3 patients (4.2%) had impingement due to abnormally fibrous bands. There were only 2 cases in which the cause of symptoms could not be detected by ankle arthroscopy, compared with 16 cases in which the cause of disability could not be detected using standard methods. In 3 cases (17.6%) of distal tibiofibular ligament injuries, 8 cases (27.6%) of osteochondral lesions, and all 3 cases (100%) of impingement of an abnormal fibrous band, ankle arthroscopy was the only method capable of diagnosing the cause of residual ankle pain after a sprain. CONCLUSION: The present results suggest that arthroscopy can be used to diagnose the cause of residual pain after an ankle sprain in most cases that are otherwise undiagnosable by clinical examination and imaging study.

Adolescent↗
PubMedDate not supplied

Three-dimensional kinematics of the taped ankle before and after exercise.

The practice of prophylactic ankle taping or wrapping to reduce the incidence of inversion ankle sprains in athletes has come under attack. The purpose of this study was to measure objectively one ankle taping technique's ability to withstand the stresses placed upon it by a standardized exercise routine. Electrogoniometers were used to measure the three-dimensional ankle motion of 20 subjects walking on a level surface and a 10 degrees sideslope. The evaluations were carried out under these three conditions: (1) both ankles untaped, (2) both ankles taped before exercises, and (3) both ankles taped after exercise. The results from this study indicate that the tape does indeed restrict those motions associated with inversion ankle sprain. Methods similar to those described in this study could be used in the evaluation of many current training room practices and thereby provide an objective rationale for their application.

Adult↗
PubMedDate not supplied

Analysis of athletic performance with prophylactic ankle devices.

We evaluated the effect of different ankle support devices on athletic performance. Thirty varsity college athletes were tested with both ankles supported by taping, Swede-O brace, Kallassy brace or left unsupported. The athletes performed four events: broad jump, vertical leap, 10 yard shuttle run, and 40 yard sprint. The events and appliances were randomized to prevent bias by fatigue. Compared to the results when no support was used, ankle taping resulted in a significant decreased performance in the vertical jump (4%), shuttle run (1.6%), and sprint (3.5%) (P less than 0.05). Use of the Swede-O brace decreased performance in the vertical jump (4.6%), broad jump (3.6%), and time of the sprint (3.2%). Results using the Kallassy brace showed a decrease in the vertical jump (3.4%) when compared to no support. The test results of the shuttle run with taping were slower than the Kallassy brace (P less than 0.05). Wearing the Swede-O brace caused the athletes' broad jump distance to decrease more than the Kallassy brace (P less than 0.05). Subjective questionnaires supported the Kallassy brace as the most comfortable support and the one that decreased performance the least. Taping of the ankles is universally accepted for ankle prophylaxis. This study has shown a decrease in performance when ankles are taped compared to ankles with no protection. Since the decreases in performance caused by ankle braces are minor, this should not be used as a criterion for selection of prophylactic support compared to taping.

Ankle Injuries↗
PubMedDate not supplied

Reconstruction of the lateral ankle ligaments. A biomechanical analysis.

UNLABELLED: The purpose of this study was to perform a biomechanical analysis of several commonly performed operative procedures used to stabilize the lateral ankle. We performed the Evans, Watson-Jones, and Chrisman-Snook procedures on 15 cadaveric ankles and tested the ankles for stability, motion, and isometry of graft placement. The Evans procedure allowed increased anterior displacement, internal rotation, and tilt of the talus when compared to ankles with intact ligaments. Subtalar joint motion was restricted by the Evans procedure. The Watson-Jones procedure controlled internal rotation and anterior displacement of the talus, but was less effective in controlling talar tilt and also restricted subtalar joint motion. The Chrisman-Snook procedure allowed increased internal rotation and anterior displacement of the talus when compared to ankles with intact ligaments. The procedure was effective in limiting talar tilt, but restricted subtalar joint motion. Based on the biomechanical data obtained, we devised a lateral ankle reconstruction with bone tunnels that reproduce the anatomic orientation of both the anterior talofibular and calcaneofibular ligaments. This ankle ligament reconstruction resists anterior displacement, internal rotation, and talar tilt without restricting subtalar joint motion. CLINICAL RELEVANCE: We found considerable mechanical differences among the more commonly performed lateral ankle reconstructions. It is possible to locate bone tunnels and graft placement so that a more anatomic configuration is achieved.

Adult↗
PubMedDate not supplied

A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis.

A study was undertaken to evaluate the effect of a semi-rigid ankle orthosis (Sport-Stirrup) on the incidence of ankle sprains in soccer players during 1 playing season. Senior soccer players were divided into 2 groups: players with previous ankle sprains (N = 258) and players without such history (N = 246). The players in these groups were each randomly allocated to either a semi-rigid orthosis or a control group at the start of the playing season. All subsequent injuries during the season and the total number of playing hours were documented. There was a significant reduction in the incidence of ankle sprains (injuries/1000 playing hours) by ankles in the orthosis group with previous sprains (0.14) compared with the nonbraced group with previous sprains (0.86). The incidence of ankle sprains was significantly higher in the nonbraced group with previous sprains (0.86) compared with the nonbraced group without previous sprains (0.46). Thus, in this study, a semirigid orthosis significantly reduced the incidence of recurrent ankle sprains in soccer players with previous history of ankle sprains.

Ankle Injuries↗
PubMedDate not supplied

Test-retest reliability of ankle injury risk factors.

Ligamentous instability, ankle muscle weakness, foot-ankle alignment, and generalized joint laxity may be predisposing factors for ankle ligament injuries. The purpose of this study was to examine the reliability of these risk factors before and after the season in healthy individuals and to determine if any significant differences developed during the athletic season (range, 12 to 16 weeks). Twenty-one healthy college-aged athletes were tested for generalized joint laxity, anatomic alignment of the foot and ankle, ligamentous stability, and isokinetic strength of the ankle muscles. This study showed that generalized joint laxity, ankle ligamentous stability, and ankle strength measurements demonstrated high correlation coefficients (r > 0.75). The high correlation coefficients suggested reliable measures. Some of the range of motion measurements had lower correlation coefficients, which suggested more variability in these measurements. After establishing the reliability in 24 of the 28 measurements with standardized methods, further work is underway to evaluate the role of these factors in inversion ankle sprains.

Adult↗
PubMedDate not supplied

Diagnosis of anterolateral ankle impingement. Comparison between magnetic resonance imaging and clinical examination.

We reviewed 22 patients who had arthroscopic evaluations and preoperative magnetic resonance imaging studies of their ankles because of chronic anterolateral ankle pain after sprains. The ability of surgeons to use the initial clinical examination to predict arthroscopically confirmed anterolateral ankle impingement was compared with the ability to predict this condition using preoperative magnetic resonance imaging. The patient population consisted of 15 men and 7 women who had an average age of 28 years. Five patients (23%) were intercollegiate athletes and 17 patients (77%) were recreational athletes. All patients reported previous traumas to the involved ankles, and all were seen with chronic ankle pain. Clinical examinations were used to assess ankle pain, swelling, range of motion, and stability. Anterolateral ankle impingement was confirmed in 18 patients (82%) with arthroscopic examination. Clinical examinations had a sensitivity of 94% and a specificity of 75% for predicting impingement, and magnetic resonance imaging had a sensitivity of 39% and a specificity of 50%. The results of this study suggest that preoperative magnetic resonance imaging examination is not beneficial or cost-effective in the diagnosis of anterolateral ankle impingement; furthermore, its use may cause further delay in treatment.

Adult↗
PubMedDate not supplied

Prospective evaluation of the Ottawa Ankle Rules in a university sports medicine center. With a modification to increase specificity for identifying malleolar fractures.

In a sports medicine center, we prospectively evaluated the Ottawa Ankle Rules over 1 year for their ability to identify clinically significant ankle and midfoot fractures and to reduce the need for radiography. We also developed a modification to improve specificity for malleolar fracture identification. Patients with acute ankle injuries (< or = 10 days old) had the rules applied and then had radiographs taken. Sensitivity, specificity, and the potential reduction in the use of radiography were calculated for the Ottawa Ankle Rules in 132 patients and for the new "Buffalo" rule in 78 of these patients. There were 11 clinically significant fractures (fracture rate, 8.3% per year). In these 132 patients, the Ottawa Ankle Rules would have reduced the need for radiography by 34%, without any fractures being missed (sensitivity 100%, specificity 37%). In 78 patients, the specificity for malleolar fracture for the new rule was significantly greater than that of the Ottawa Ankle Rules malleolar rule (59% versus 42%), sensitivity remained 100%, and the potential reduction in the need for radiography (54%) was significantly greater. The Ottawa Ankle Rules could significantly reduce the need for radiography in patients with acute ankle and midfoot injuries in this setting without missing clinically significant fractures. The Buffalo modification could improve specificity for malleolar fractures without sacrificing sensitivity and could significantly reduce the need for radiography.

Adolescent↗