I agree with the finding, 24 hours after the injury the punter seems to
have posterior malleolar tenderness. I can't remember from the original
papers from Ottawa whether there was a time limit on the patients, theres
early dementia for you.
I haven't seen any papers myself on timecourse of symptoms, it seems not to
be a feature in most studies.
Any one out there want to do the work?
The numbers will need a multisite study I imagine
Andy Volans
Scarborough
>
>It's been my clinical impression over the years that patients attending
>with ankle injuries over 24 hrs are more likely to need an X ray using
>the Ottawa guidelines. However the pick up rate for fractures seems >less.
There are three possible reasons for this:
>
>a) swelling and inflammation spreads over the time period, so that pain
>on palpation that was initially limited spreads to the posterior aspect
>of the lateral malleolus.
>
>b) I'm seeing a self selected group who present late.
>
>c) it's a false observation.
>
>I wonder has any paper serially examined the injured ankles on a daily
>basis to note any change in the clinical signs thus triggering an
>"indication" for X Ray?
>
>
>Ray McGlone
>
>A&E Consultant
>Lancaster
>
>
>
>________________________________________________________________________
>This email has been scanned using the MessageLabs SkyScan >antivirus
>system. Funded for members by the Doctors.net.uk Bulletin >service
>How does this protect me? http://www.Doctors.net.uk/qualityemail>
>________________________________________________________________________
>
>
>
________________________________________________________________________
All email and attachments sent from http://www.Doctors.net.uk have been
scanned by the MessageLabs SkyScan antivirus system
________________________________________________________________________
|