By Dr. Kathy Boutis
Ankle injuries in children are commonly seen in emergency rooms. At present, x-rays are ordered routinely in most children with ankle trauma, because of patients' and parents' expectations and physicians' fear of overlooking serious injury.
This approach may lead to unnecessary X-rays, resulting in increased radiation exposure and health-care expenditure, as well as longer waiting times in the emergency room.
The Ottawa ankle rules reduce the need for X-rays in a subset of adults with ankle trauma. These rules state that ankle radiographs are needed only if there is one or more of the following:
Previous work has shown that the Ottawa ankle rules could also reduce the need for X-rays in children. Many young children with a mild isolated ankle injury refuse to bear weight and are therefore thought to need X-rays according to the Ottawa ankle rules.
In this study, it was postulated that in children with clinical findings restricted to the outside of the ankle bone or the area immediately around it, or both, X-rays may not determine the course of treatment, thereby potentially eliminating the need for X-rays.
The study showed that no children with acute ankle injury and pain restricted to the outside ankle bone below the level of the joint line of the ankle or immediately next to it had a serious problem.
Therefore, nearly two-thirds of the X-rays currently undertaken could be avoided on the basis of low-risk examination alone, by contrast there is only 12% reduction in imaging based on application of the Ottawa algorithm.
This finding could substantially reduce costs and improve flow of patients in the emergency department, without increasing the likelihood of missing clinically significant high-risk fractures.
The low-risk and high-risk findings were easily distinguished by the clinicians, as assessed by a high degree of agreement between observers.
Abstracted from Lancet December 22, 2001; 358: 2118-21
If you have children this study can help you determine if an X-ray is required to rule out a fracture.
Most of the time X-rays are not required, but if they are and the bone is broken, that is the time when conventional medicine seems to do quite well.
However, if the ankle is merely sprained NST is a wonderful tool to accelerate healing and reduce the time of disability.
It was an ankle injury that originally prompted me to learn NST. In the summer of 2000 I was in a friendly race down a mountain. Having not done this before, I wasn't as focused as I needed to be, and I twisted my ankle quite severely, tearing many of the ligaments in my ankle.
To complicate matters it was a remote mountain with no one else around, and I had to run six more miles back to the lodge on the injured ankle.
The ankle bothered me for many months, but after a few NST treatments the pain completely resolved.
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