Assessing the use of the Ottawa ankle rules when investigating traumatic pathology of the foot and ankle in a Maltese primary care setting

Abstract

Background The judicious use of ankle and foot radiography should balance a correct diagnosis in all cases of traumatic distal lower limb fractures with the avoidance of unnecessary radiation exposure for the patient. For this objective the Ottawa ankle and foot rules (OAR) have long been established as valuable and proven tools for such assessments. The doctor’s requests should provide all the necessary information to allow correct interpretation of the x-rays as well as for research purposes. Objective A prospective study was carried out to evaluate use of the criteria in the OAR over a four week period to assess the need for foot and ankle x-rays in a Maltese public health centre. It also sought to assess whether the related documentation is appropriate. Method All the requests for ankle and foot x-rays made during August 2016 in a Maltese primary health centre were analysed. The data were obtained from the Radiology Information System, the programme used for electronic referral, and from patients’ health centre files. The demographic and clinical information obtained was analysed for use of the criteria in the OAR. Results In total, 75 patients had an ankle and/or foot x-ray taken, with fractures detected in 15 patients. There was evidence for use of the OAR in only 36 cases (48%). Minor differences were noted in the information recorded in the patients’ files and in the electronic referrals. Conclusions Use of radiological services in primary care is useful in diagnosing ankle and foot traumatic pathology, but knowledge and use of the OAR is recommended to decrease the number of x-rays taken.