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