Without the benefit of papers, has anyone who has suffered a soft tissue
injury of the lower limb not noticed how appearances and swelling change
with time. Immediately there is little to see but after a couple of days
there is much; swelling, bruising, pain, loss of function. Time must be
relevant in this so Ottawa rules OK only if time is considered. Late
ankles always seem worse because the patient has, more than likely, had no
expert treatment. My understanding of Ottawa is a rule to decrease
unnecessary xrays. The late ankle looks exactly the same as a broken one,
so damn the examination and do the films. Safer, quicker and patients like
it. Unstable ankles needing referral I believe to be quite rare. Does
anyone still do stress xrays, lateral or AP? I used to do lots in my SR
days, and found 1 positive drawer sign on xray, which must be in a museum
now.
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