AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentEasy
A 6-year-old child presents after a fall from a bicycle, complaining of right ankle pain and inability to bear weight. On examination, there is tenderness over the posterior edge of the lateral malleolus and the base of the fifth metatarsal. According to the Ottawa Ankle Rules, which of the following is the most appropriate next step?
- AImmobilize the ankle in a posterior splint and refer to orthopedics.
- BPrescribe NSAIDs and advise rest for 3-5 days.
- CApply ice and elevation, then discharge home with crutches and follow-up in 24 hours.
- DOrder X-rays of the ankle and foot.
Show answer & explanationAnswer & explanation
Correct answer: D. Order X-rays of the ankle and foot.
The Ottawa Ankle Rules are a clinical decision-making tool used to determine the need for imaging in ankle injuries. Tenderness over the posterior edge of either malleolus or the base of the fifth metatarsal, coupled with inability to bear weight, are positive criteria indicating the need for X-rays to rule out a fracture.
Why the other options are wrong
- A. Immobilization might be needed, but only after a fracture is ruled out or confirmed by imaging.
- B. NSAIDs and rest are supportive measures, but X-rays are required first to assess for fracture.
- C. Discharging without imaging when Ottawa Ankle Rules are positive could miss a fracture.
Ottawa Ankle Rules
A set of clinical decision rules to determine if a patient with an acute ankle injury requires radiography.
- High sensitivity for detecting ankle and midfoot fractures.
- Reduces unnecessary X-rays.
- Criteria include specific bony tenderness and inability to bear weight.
Memory trick: Ottawa RULES for 'R'adiographs when 'U'ncertain.