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The Ottawa Ankle Rules are based on the premise that avulsion fractures <3
mm in size are not clinically significant in adults and do not require
casting.  A small study* (n=71) suggests that these rules might be
sensitive in children as well (95% confidence interval 77%-100%).
 
Is the same 3 mm casting threshold appropriate for children?  Is it the
current standard of care to cast or not cast, say a 2.5 mm ankle avulsion
fracture in a three year-old?  At my hospital all children with
radiographically visible fracture fragments are casted, but apparently this
is not the case everywhere.
 
I'd like to hear both thoughts on this subject and what is done at other
centers.
 
 
Steve Green, MD, FACEP
Director, Emergency Medicine Residency Program
Professor of Emergency Medicine
Loma Linda University Medical Center & Children's Hospital
Loma Linda, California
 
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*Chande VT:  Decision rules for roentgenography of children with acute
ankle injuries.  Arch Pediatr Adolesc Med 1995; 149:255-8.
 
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