Diagnostic performance of the Bernese versus Ottawa ankle rules: Results of a randomised controlled trial

Derksen, R.J.; Knijnenberg, Lisa M; Fransen, Gerwin; Breederveld, R.S.; Heymans, Martijn W.; Schipper, I.B.

doi:10.1016/j.injury.2015.03.038

Cited by 16 publications

(11 citation statements)

References 15 publications

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“…The Bernese ankle rules (BAR) have been developed as response to the high rate of unnecessary radiographs based on OAR findings. However, the sensitivity of the BAR is too low to promote clinical use74 (level 2).…”

Section: Resultsmentioning

confidence: 99%

Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

et al. 2018

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This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4–5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.

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Section: Resultsmentioning

confidence: 99%

Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

et al. 2018

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“…In these 18 studies, the diagnostic accuracy of the following ankle decision rules is discussed: Ottawa Ankle Rules (OAR), Tuning Fork Test, LRAR, Malleolar Zone Algorithm, Midfoot Zone Algorithm, and Bernese Ankle Rules. Table 1 depicts the study characteristics of all the studies included (5)(6)(7)12,13,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Table 2 gives the assessed methodological quality according to QUADAS-2 (5)(6)(7)12,13,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36).…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 depicts the study characteristics of all the studies included (5)(6)(7)12,13,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Table 2 gives the assessed methodological quality according to QUADAS-2 (5)(6)(7)12,13,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36).…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of Clinical Decision Rules to Exclude Fractures in Acute Ankle Injuries: Systematic Review and Meta-analysis

Barelds

Krijnen

Leur

et al. 2017

The Journal of Emergency Medicine

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“…[38][39][40] This would suggest a risk of a patient failing to receive baseline imaging if evidence-based guidelines for imaging are followed. Because the Ottawa Ankle Rules do not always achieve 100% sensitivity, [41][42][43] it may be of value to add medial cuneiform tenderness to the rules to minimize the chance of a missed fracture. Other authors have similarly suggested updates to the Ottawa Ankle Rules to improve overall yield.…”

Section: Discussionmentioning

confidence: 99%

Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies

Mabry¹,

Patti²,

Ross³

et al. 2021

Journal of the American Podiatric Medical Association

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Background Isolated medial cuneiform fracture is a rare but diagnostically challenging condition. Diagnostic delay in these cases may lead to delays in ideal treatment approaches and prolonged symptoms. An understanding of clinical presentation is needed to expedite diagnosis, facilitate decision making, and guide treatment approach. Methods Case studies/series were searched in four databases until September 2019. Included studies had participants with a history of traumatic closed medial cuneiform fracture. Studies were excluded if the medial cuneiform fractures were open fractures, associated with multitrauma, or associated with dislocation/Lisfranc injury. Three blinded reviewers assessed the methodological quality of the studies, and a qualitative synthesis was performed. Results Ten studies comprising 15 patients were identified. Mean ± SD patient age was 38.0 ± 12.8 years, with 86.7% of reported participants being men. The overall methodological quality was moderate to high, and reporting of the patient selection criteria was poor overall. The most commonly reported clinical symptoms were localized tenderness (60.0%) and edema (53.3%). Direct blow was the most common inciting trauma (46.2%), followed by axial load (30.8%) and avulsion injuries (23.1%). Baseline radiographs were occult in 72.7% of patients; magnetic resonance imaging and computed tomography were the most common diagnostic modalities. Mean ± SD diagnostic delay was 64.7 ± 89.6 days. Conservative management was pursued in 54.5% of patients, with reported resolution of symptoms in 3 to 6 months. Surgical intervention occurred in 45.5% of patients and resulted in functional restoration in 3 to 6 months in all but one patient. Conclusions Initial radiographs for isolated medial cuneiform fractures are frequently occult. Due to expedience and relatively low cost, radiographs are still a viable first-line imaging modality. If clinical concern remains, magnetic resonance imaging may be pursued to minimize diagnostic delay. Conservative management is a viable treatment method, with expected return to full function in 3 to 6 months.

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Diagnostic performance of the Bernese versus Ottawa ankle rules: Results of a randomised controlled trial

Cited by 16 publications

References 15 publications

Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

Diagnostic Accuracy of Clinical Decision Rules to Exclude Fractures in Acute Ankle Injuries: Systematic Review and Meta-analysis

Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies

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