I agree Charles, Ottowa and the like are designed for acutely presenting
patients. Such rules aren't so easily applied to late presenters. Rather, as
I do with those patients who can't communicate a history for whatever
reason, I drop my thresholds for investigation, and generally x-ray them.
AF
----- Original Message -----
From: "Scott, Charles" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 24, 2003 12:30 PM
Subject: ankle injuries
> 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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