Journal articles: 'Ottawa Ankle Rules'

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Holt, Lynda. "Ottawa ankle rules." Emergency Nurse 6, no. 8 (December 1998): 5. http://dx.doi.org/10.7748/en.6.8.5.s10.

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Bachmann, L. M. "Ottawa ankle rules: Authors' reply." BMJ 326, no. 7399 (May 22, 2003): 1147—c—1147. http://dx.doi.org/10.1136/bmj.326.7399.1147-c.

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Heyworth, J. "Ottawa ankle rules for the injured ankle." British Journal of Sports Medicine 37, >3 (June 1, 2003): 194. http://dx.doi.org/10.1136/bjsm.37.3.194.

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Heyworth, J. "Ottawa ankle rules for the injured ankle." BMJ 326, no. 7386 (February 22, 2003): 405–6. http://dx.doi.org/10.1136/bmj.326.7386.405.

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Holt, Lynda. "The value of ottawa ankle rules." Emergency Nurse 11, no. 1 (April 2003): 7. http://dx.doi.org/10.7748/en.11.1.7.s11.

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&NA;. "Ottawa Ankle Rules Reduce Unnecessary Radiography." Nurse Practitioner 19, no. 5 (May 1994): 32. http://dx.doi.org/10.1097/00006205-199405000-00009.

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Yuen, M. C. "The Ottawa ankle rules in children." Emergency Medicine Journal 18, no. 6 (November 1, 2001): 466–67. http://dx.doi.org/10.1136/emj.18.6.466.

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Araujo, David. "Can Ottawa Ankle Rules Be Improved?" Physician and Sportsmedicine 26, no. 9 (September 1998): 14. http://dx.doi.org/10.1080/00913847.1998.11440458.

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Bachmann, Lucas M., and Gerben ter Riet. "The Ottawa rules for ankle sprains." Hospital Medicine 65, no. 3 (March 2004): 132–33. http://dx.doi.org/10.12968/hosp.2004.65.3.12388.

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Stiell, I. G. "Implementation of the Ottawa ankle rules." JAMA: The Journal of the American Medical Association 271, no. 11 (March 16, 1994): 827–32. http://dx.doi.org/10.1001/jama.271.11.827.

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Taub, Marc David. "Implementation of the Ottawa ankle rules." Journal of Emergency Medicine 12, no. 6 (November 1994): 870. http://dx.doi.org/10.1016/0736-4679(94)90505-3.

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Stiell, Ian G. "Implementation of the Ottawa Ankle Rules." JAMA: The Journal of the American Medical Association 271, no. 11 (March 16, 1994): 827. http://dx.doi.org/10.1001/jama.1994.03510350037034.

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Leddy, John J., Robert J. Smolinski, James Lawrence, Jody L. Snyder, and Roger L. Priore. "Prospective Evaluation of the Ottawa Ankle Rules in a University Sports Medicine Center." American Journal of Sports Medicine 26, no. 2 (March 1998): 158–65. http://dx.doi.org/10.1177/03635465980260020201.

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In a sports medicine center, we prospectively evaluated the Ottawa Ankle Rules over 1 year for their ability to identify clinically significant ankle and midfoot fractures and to reduce the need for radiography. We also developed a modification to improve specificity for malleolar fracture identification. Patients with acute ankle injuries ( 10 days old) had the rules applied and then had radiographs taken. Sensitivity, specificity, and the potential reduction in the use of radiography were calculated for the Ottawa Ankle Rules in 132 patients and for the new “Buffalo” rule in 78 of these patients. There were 11 clinically significant fractures (fracture rate, 8.3% per year). In these 132 patients, the Ottawa Ankle Rules would have reduced the need for radiography by 34%, without any fractures being missed (sensitivity 100%, specificity 37%). In 78 patients, the specificity for malleolar fracture for the new rule was significantly greater than that of the Ottawa Ankle Rules malleolar rule (59% versus 42%), sensitivity remained 100%, and the potential reduction in the need for radiography (54%) was significantly greater. The Ottawa Ankle Rules could significantly reduce the need for radiography in patients with acute ankle and midfoot injuries in this setting without missing clinically significant fractures. The Buffalo modification could improve specificity for malleolar fractures without sacrificing sensitivity and could significantly reduce the need for radiography.

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McLaughlin, Steven A., Douglas S. Binder, and David P. Sklar. "Ottawa Ankle Rules and the Diabetic Foot." Annals of Emergency Medicine 32, no. 4 (October 1998): 518. http://dx.doi.org/10.1016/s0196-0644(98)70190-8.

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McCarter, D. F. "Clinical application of the Ottawa ankle rules." JAMA: The Journal of the American Medical Association 272, no. 7 (August 17, 1994): 518b—518. http://dx.doi.org/10.1001/jama.272.7.518b.

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McCarter, Daniel F. "Clinical Application of the Ottawa Ankle Rules." JAMA: The Journal of the American Medical Association 272, no. 7 (August 17, 1994): 518. http://dx.doi.org/10.1001/jama.1994.03520070036031.

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Pijnenburg, A. C. M., Afina S. Glas, Marnix A. J. de Roos, Kjell Bogaard, Jeroen G. Lijmer, Patrick M. M. Bossuyt, Rudolf M. J. M. Butzelaar, and Johannes N. Keeman. "Radiography in acute ankle injuries: The Ottawa Ankle Rules versus local diagnostic decision rules." Annals of Emergency Medicine 39, no. 6 (June 2002): 599–604. http://dx.doi.org/10.1067/mem.2002.121397.

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CLARK, KATHRYN D., and SUZANNE TANNER. "Evaluation of the Ottawa Ankle Rules in children." Pediatric Emergency Care 19, no. 2 (April 2003): 73–78. http://dx.doi.org/10.1097/00006565-200304000-00003.

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Perry, S., N. Raby, and P. T. Grant. "Prospective survey to verify the Ottawa ankle rules." Emergency Medicine Journal 16, no. 4 (July 1, 1999): 258–60. http://dx.doi.org/10.1136/emj.16.4.258.

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Libetta, C., D. Burke, P. Brennan, and J. Yassa. "Validation of the Ottawa ankle rules in children." Emergency Medicine Journal 16, no. 5 (September 1, 1999): 342–44. http://dx.doi.org/10.1136/emj.16.5.342.

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Mccann, B. "Prospective survey to verify the Ottawa ankle rules." Emergency Medicine Journal 17, no. 1 (January 1, 2000): 75—b—76. http://dx.doi.org/10.1136/emj.17.1.75-b.

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Fogarty, A. "Ottawa ankle rules: Sign may not be objective." BMJ 326, no. 7399 (May 22, 2003): 1147—a—1147. http://dx.doi.org/10.1136/bmj.326.7399.1147-a.

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Anis, Aslam H., Ian G. Stiell, David G. Stewart, and Andreas Laupacis. "Cost-Effectiveness Analysis of the Ottawa Ankle Rules." Annals of Emergency Medicine 26, no. 4 (October 1995): 422–28. http://dx.doi.org/10.1016/s0196-0644(95)70108-7.

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BATES, BETSY. "Ottawa Ankle Rules Sort Out Sprains From Breaks." Pediatric News 42, no. 2 (February 2008): 43. http://dx.doi.org/10.1016/s0031-398x(08)70082-1.

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Broomhead, Alan, and Peter Stuart. "Validation of the Ottawa Ankle Rules in Australia." Emergency Medicine Australasia 15, no. 2 (April 2003): 126–32. http://dx.doi.org/10.1046/j.1442-2026.2003.00430.x.

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Stiell, Ian G. "Clinical Application of the Ottawa Ankle Rules-Reply." JAMA: The Journal of the American Medical Association 272, no. 7 (August 17, 1994): 518. http://dx.doi.org/10.1001/jama.1994.03520070036032.

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Auleley, Guy-Robert. "Implementation of the Ottawa Ankle Rules in France." JAMA 277, no. 24 (June 25, 1997): 1935. http://dx.doi.org/10.1001/jama.1997.03540480035035.

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Thakur, Abhishek Kumar, and Prakriti Raj Kandel. "Reliability of ‘Ottawa Ankle Rules’ in Acute Ankle and Midfoot Injuries." Journal of Universal College of Medical Sciences 10, no. 01 (August 9, 2022): 33–36. http://dx.doi.org/10.3126/jucms.v10i01.47218.

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INTRODUCTIONThe Ottawa ankle rules (OARs) are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The OARs have been proven that their application reduces unnecessary radiography. MATERIAL & METHODSThis prospective study was conducted at Sumeru City Hospital, Lalitpur in the Department of Emergency and Outpatient Department of Orthopaedics. Thirty-six patients were included in the study. Twenty-five patients were in ankle group and 11 patients were in midfoot group. All patients were sent for X-rays after evaluating them according to OARs. RESULTS Among 36 cases, 8 clinically significant fractures were found. Sensitivity of OARs for detecting fractures was 100 % for both ankle and midfoot group. Specificity of OARs for detecting fractures were 47.36 % for ankle group and 66.67 % for midfoot group. Negative predictive value of OARs was 100 %. CONCLUSIONOARs are very accurate and highly sensitive tools for detecting fractures in acute ankle and midfoot injuries. Implementation of these rules would lead to significant reduction in the number of radiographs and thereby reduce the cost of the treatment, radiation exposure and waiting time of patients at hospital.

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Plint, Amy C., Blake Bulloch, Martin H. Osmond, Ian Stiell, Hal Dunlap, Martin Reed, Milton Tenenbein, and Terry P. Klassen. "Validation of the Ottawa Ankle Rules in Children with Ankle Injuries." Academic Emergency Medicine 6, no. 10 (October 1999): 1005–9. http://dx.doi.org/10.1111/j.1553-2712.1999.tb01183.x.

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Jenkin, Michelle, Michael R. Sitler, and John D. Kelly. "Clinical Usefulness of the Ottawa Ankle Rules for Detecting Fractures of the Ankle and Midfoot." Journal of Athletic Training 45, no. 5 (September 1, 2010): 480–82. http://dx.doi.org/10.4085/1062-6050-45.5.480.

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Abstract Reference: Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417–423. Clinical Question: What is the evidence for the accuracy of the Ottawa Ankle Rules as a decision aid for excluding fractures of the ankle and midfoot? Data Sources: Studies were identified by searching MEDLINE and PreMEDLINE (Ovid version: 1990 to present), EMBASE (Datastar version: 1990–2002), CINAHL (Winspires version: 1990–2002), the Cochrane Library (2002, issue 2), and the Science Citation Index database (Web of Science by Institute for Science Information). Reference lists of all included studies were also searched, and experts and authors in the specialty were contacted. The search had no language restrictions. Study Selection: Minimal inclusion criteria consisted of (1) study assessment of the Ottawa Ankle Rules and (2) sufficient information to construct a 2 × 2 contingency table specifying the false-positive and false-negative rates. Data Extraction: Studies were selected in a 2-stage process. First, all abstracts and titles found by the electronic searches were independently scrutinized by the same 2 authors. Second, copies of all eligible papers were obtained. A checklist was used to ensure that all inclusion criteria were met. Disagreements related to the eligibility of studies were resolved by consensus. Both authors extracted data from each included study independently. Methods of data collection, patient selection, blinding and prevention of verification bias, and description of the instrument and reference standard were assessed. Sensitivities (using the bootstrap method), specificities, negative likelihood ratios (using a random-effects model), and their standard errors were calculated. Special interest was paid to the pooled sensitivities and negative likelihood ratios because of the calibration of the Ottawa Ankle Rules toward a high sensitivity. Exclusion criteria for the pooled analysis were (1) studies that used a nonprospective data collection, (2) unknown radiologist blinding (verification bias), (3) studies assessing the performance of other specialists (nonphysicians) using the rules, and (4) studies that looked at modifications to the rules. Main Results: The search yielded 1085 studies, and the authors obtained complete articles for 116 of the studies. The reference lists from these studies provided an additional 15 studies. Only 32 of the studies met the inclusion criteria and were used for the review; 5 of these met the exclusion criteria. For included studies, the total population was 15 581 (range = 18–1032), and average age ranged from 11 to 31.1 years in those studies that reported age. The 27 studies analyzed (pooled) consisted of 12 studies of ankle assessment, 8 studies of midfoot assessment, 10 studies of both ankle and midfoot assessment, and 6 studies of ankle or midfoot assessment in children (not all studies assessed all regions). Pooled sensitivities, specificities, and negative likelihood ratios for the ankle, midfoot, and combined ankle and midfoot are presented in the Table. Based on a 15% prevalence of actual fracture in patients presenting acutely after ankle or foot trauma, less than a 1.4% probability of fracture existed. Because limited analysis was conducted on the data from the children, we elected to not include this cohort in our review. Conclusions: Evidence supports the use of the Ottawa Ankle Rules as an aid in ruling out fractures of the ankle and midfoot. The rules have a high sensitivity (almost 100%) and modest specificity. Use of the Ottawa Ankle Rules holds promise for saving time and reducing both costs and radiographic exposure without sacrificing diagnostic accuracy in ankle and midfoot fractures.

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Mandal, Malay K., Anirban Paul, Abhijit Sen, S. Sariful Rahman, and Bimalendu Bikash Hazra. "Utility of Ottawa ankle rules in excluding ankle fractures in Indian scenario." International Journal of Research in Orthopaedics 8, no. 1 (December 24, 2021): 30. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20214459.

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Background: Patients with acute ankle injuries form a major bulk in outdoor and emergency room, and many of them get radiographs done to rule out fractures. Ottawa ankle rules (OAR) may reduce the need for unnecessary radiographs by detecting fractures only with help of simple clinical findings. We conducted this study to see the extent of usefulness of these rules in our day-to-day practice.Methods: Our study is observational in nature. A total of 107 patients who visited the clinic of the chief investigator between the time period from 1st January 2019 to 31st December 2020, fulfilling inclusion criteria and willing to participate, were enrolled. The patients were examined clinically, and the assessor recorded the findings on a previously prepared assessment form. Data analysis was done from the master chart.Results: Among the 107 patients, 46 patients were ‘suspicion positive’ by OAR. After the radiographic assessment, we found 11 fractures, all of which belonged to the ‘suspicion positive’ group. Statistical analysis showed that OAR had a sensitivity of 100% for ankle fractures, whereas specificity for the same was 63.54%. We found the positive predictive value to be 23.91% and negative predictive value to be 100%, positive likelihood ratio of 2.74, and negative likelihood ratio of 0.Conclusions: OAR is an easy and reliable tool to screen ankle fractures. In a country with as massive a health care burden as ours, it can reduce the number of unnecessary radiographs and thus reduce exposure, cost, and time of medical professionals.

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David, Shannon, Kim Gray, Jeffrey A. Russell, and Chad Starkey. "Validation of the Ottawa Ankle Rules for Acute Foot and Ankle Injuries." Journal of Sport Rehabilitation 25, no. 1 (February 2016): 48–51. http://dx.doi.org/10.1123/jsr.2014-0253.

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The original and modified Ottawa Ankle Rules (OARs) were developed as clinical decision rules for use in emergency departments. However, the OARs have not been evaluated as an acute clinical evaluation tool.Objective:To evaluate the measures of diagnostic accuracy of the OARs in the acute setting.Methods:The OARs were applied to all appropriate ankle injuries at 2 colleges (athletics and club sports) and 21 high schools. The outcomes of OARs, diagnosis, and decision for referral were collected by the athletic trainers (ATs) at each of the locations. Contingency tables were created for evaluations completed within 1 h for which radiographs were obtained. From these data the sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated.Results:The OARs met the criteria for radiographs in 100 of the 124 cases, of which 38 were actually referred for imaging. Based on radiographic findings in an acute setting, the OARs (n = 38) had a high sensitivity (.88) and are good predictors to rule out the presence of a fracture. Low specificity (0.00) results led to a high number of false positives and low positive predictive values (.18).Conclusion:When applied during the first hour after injury the OARs significantly overestimate the need for radiographs. However, a negative finding rules out the need to obtain radiographs. It appears the AT’s decision making based on the totality of the examination findings is the best filter in determining referral for radiographs.

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Shabir, Mohammad, Shahid Iqbal, Muhammad Inam, Arif Shehzad, and Ihsanullah . "ANKLE AND MIDFOOT FRACTURES; DIAGNOSTIC ACCURACY OF OTTAWA RULES." Professional Medical Journal 24, no. 11 (November 1, 2017): 1680–84. http://dx.doi.org/10.17957/tpmj/17.4124.

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Herman, Lawrence. "A 20-year perspective on the Ottawa Ankle Rules." Journal of the American Academy of Physician Assistants 34, no. 7 (July 2021): 15–20. http://dx.doi.org/10.1097/01.jaa.0000753884.37638.da.

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Mann, C. J., I. Grant, H. Guly, and P. Hughes. "Use of the Ottawa ankle rules by nurse practitioners." Emergency Medicine Journal 15, no. 5 (September 1, 1998): 315–16. http://dx.doi.org/10.1136/emj.15.5.315.

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Brehaut, J. "Attitudes of Emergency Physicians toward the Ottawa Ankle Rules." Academic Emergency Medicine 12, Supplement 1 (May 1, 2005): 114. http://dx.doi.org/10.1197/j.aem.2005.03.321.

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Ittiq, Bilal. "Bimalleolar Fracture In Athlete With Negative Ottawa Ankle Rules." Medicine & Science in Sports & Exercise 52, no. 7S (July 2020): 204. http://dx.doi.org/10.1249/01.mss.0000675752.10651.3e.

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Rosenbaum, RA, PT Cowan, A. Bianchi, BE Burgess, and RE O'Connor. "The ottawa ankle rules: How confident are our patients?" Annals of Emergency Medicine 34, no. 4 (October 1999): S7. http://dx.doi.org/10.1016/s0196-0644(99)80106-1.

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Blackham, J. E. J., T. Claridge, and J. R. Benger. "Can patients apply the Ottawa ankle rules to themselves?" Emergency Medicine Journal 25, no. 11 (November 1, 2008): 750–51. http://dx.doi.org/10.1136/emj.2008.057877.

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Kumar, Dharmendra, Sudhir Singh, and Alok Kumar Yadav. "Ottawa Ankle Rule: An Indian Perspective." Journal of Foot and Ankle Surgery (Asia Pacific) 2, no. 1 (2015): 8–12. http://dx.doi.org/10.5005/jp-journals-10040-1020.

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ABSTRACT Introduction Foot and ankle injuries are common clinical conditions treated by orthopedic surgeons accounting for 6 to 12% of the patients seen in emergency. Currently, almost all patients with foot and ankle injuries undergo radiographic examination to exclude fractures; however, fewer than 15% of these patients actually have fractures, thus, most of these radiographs are unnecessary. Unwarranted radiographic examination increases the demands on the healthcare system and also results in prolonged patient waiting times. Ottawa ankle rule (OAR) evolved to reduce the number of radiography and waiting time for patients in emergency department by excluding fractures using only clinical examination. Although, it has good sensitivity but it has not been much popular and not included in medical curriculum. Aim The aim of the study is to implement the OAR in an Indian tertiary care trauma setup with two different levels of clinical examiners (1st year postgraduate junior resident and senior resident) and report the finding. Materials and methods This prospective study was done in the Department of Orthopedics, for a period of 15 months. Clinical examiners were shown and given a video presentation about the Oar and a printed copy of the rules were provided to all. Clinical diagnosis of both levels of clinical examiners were evaluated and analyzed. Results Three hundred cases met our inclusion criteria. In first clinical examination done by junior resident, 115 clinically significant fractures were suspected while senior resident suspected 69 fractures. Radiography showed 5 cases with missed fractures. Accuracy of OAR by JR is 82.33% and by SR is 97.0%. Conclusion Ottawa ankle rule are very effective and can identify all clinically relevant fractures of ankle and foot with increased accuracy and sensitivity when applied by a trauma specialists. Although, these rules can also be applied by general doctors so as to help them to screen patients who need radiography in acute ankle injury, but it is more sensitive when it is applied by specialist doctor. How to cite this article Singh S, Kumar D, Yadav AK. Ottawa Ankle Rule: An Indian Perspective. J Foot Ankle Surg (Asia- Pacific) 2015;2(1):8-12.

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Pope, Rod. "Ottawa Ankle Rules are more sensitive than Dutch in detecting significant ankle fracture." Australian Journal of Physiotherapy 48, no. 4 (2002): 320. http://dx.doi.org/10.1016/s0004-9514(14)60178-1.

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Anderson, Richard, Amy Green, Rhianna Davies, Lindsey Dew, and Mark Harrison. "1074 Ottawa Ankle rules cannot be safely used to rule out ankle fractures in patients who present ≥10 days post-injury." Emergency Medicine Journal 39, no. 3 (February 21, 2022): 258.3–259. http://dx.doi.org/10.1136/emermed-2022-rcem.33.

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Aims/Objectives/BackgroundThe Ottawa ankle rules (OAR) have been validated as a highly sensitive tool to rule out ankle fractures and reduce need for radiography. However, datasets validating OAR to date have excluded patients presenting ≥10 days post-injury and there is a need to ascertain if OAR can be safely used to rule out ankle fractures in this population.Methods/DesignPatients presenting with ankle injuries to an emergency department (ED) in England between June 2015 and November 2020 were identified retrospectively through a clinical-coding search. Patient records were used to confirm the number of days between injury and presentation; those who presented ≥10 days post-injury were included for further analysis. Data was collected from ED documentation including region of pain, bony tenderness and weight-bearing status. OAR were used to categorise patients as ‘Ottawa-positive’, ‘Ottawa-negative’ or insufficient documentation. It was recorded whether the patient underwent radiography and whether the formal radiograph report confirmed a clinically-significant fracture. Patients who didn’t undergo radiography and didn’t subsequently re-present were deemed not to have a fracture. Data collected for each patient was checked and agreed by two authors.Results/Conclusions6782 patients presented with ankle injuries, of which 126 patients presented ≥10 days post-injury. Of these 126 patients, 9 were Ottawa-positive, 90 were Ottawa-negative and 27 patients had insufficient documentation. 85 patients underwent radiography and 19 were found to have clinically-significant fractures. Of these fracture patients, 4 were Ottawa-positive and 15 were Ottawa-negative.Within our dataset, OAR demonstrated a sensitivity of 21.05%, specificity 93.75%, PPV 44.40% and NPV 83.30%. Using Fishers exact test, p=0.0658. OAR demonstrate poor sensitivity and cannot be safely used to rule out ankle fractures in patients who present ≥10 days post-injury. However, due to the p-value and low power there may be a risk of type 2 error and a larger study may prove otherwise.

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Ellenbogen, Amy L., Amy L. Rice, and Pranav Vyas. "Retrospective comparison of the Low Risk Ankle Rules and the Ottawa Ankle Rules in a pediatric population." American Journal of Emergency Medicine 35, no. 9 (September 2017): 1262–65. http://dx.doi.org/10.1016/j.ajem.2017.03.058.

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Morais, Bruno, André Branquinho, Mariana Barreira, Joana Correia, Marino Machado, Nuno Marques, Ana Ferrão, João Nóbrega, Frederico Teixeira, and Nuno Diogo. "Validation of the Ottawa ankle rules: Strategies for increasing specificity." Injury 52, no. 4 (April 2021): 1017–22. http://dx.doi.org/10.1016/j.injury.2021.01.006.

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Runyon, Michael S. "Can We Safely Apply the Ottawa Ankle Rules to Children?" Academic Emergency Medicine 16, no. 4 (April 2009): 352–54. http://dx.doi.org/10.1111/j.1553-2712.2009.00370.x.

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Bukata, W. Richard. "Ottawa Ankle Rules Work, but Are Rarely Used by EPs." Emergency Medicine News 26, no. 12 (December 2004): 8. http://dx.doi.org/10.1097/00132981-200412000-00009.

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Warren, N. P. "The Ottawa Ankle Rules and missed fractures of the talus." Emergency Medicine Journal 18, no. 6 (November 1, 2001): 521. http://dx.doi.org/10.1136/emj.18.6.521.

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Jennings, V., C. Newton, K. Bonner, and R. Hancock. "Clinical audit and the implementation of the Ottawa Ankle Rules." Clinical Governance: An International Journal 10, no. 1 (March 2005): 59–61. http://dx.doi.org/10.1108/14777270510579314.

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Ali, Khalid, and John Addison. "Traumatic ankle pain - adequacy of clinical information with reference to the Ottawa ankle rules." Clinical Radiology 67 (September 2012): S13. http://dx.doi.org/10.1016/j.crad.2012.06.070.

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Cydulka, R. K. "Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot." Annals of Emergency Medicine 43, no. 5 (May 2004): 675–76. http://dx.doi.org/10.1016/j.annemergmed.2004.02.023.

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Journal articles on the topic 'Ottawa Ankle Rules'

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