Implementation of the Low Risk Ankle Rule

Exclusion Criteria

• •1. Children with ankle injuries who were referred from outside the hospital with radiographs.
• •2. Children with ankle injuries who returned for reassessment of the same ankle injury.
• •3. Children with open wounds on their ankle and/or foot
• •4. All children at risk for pathological fractures such as those with congenital or acquired generalized bony disease (Appendix I). Clinical presentation and risks in these cases may be altered.
• •5. Congenital anomalies of the feet and/or ankles (eg club feet, tarsal coalition). These abnormalities may have features which may complicate clinical assessment.
• •6. Patients with known coagulopathies. Underlying hemarthrosis may complicate clinical assessment.
• •7. Patients with cognitive and/or developmental delay. These patients may not localize pain.
• •8. Injuries greater than 72 hours old. The signs and symptoms of the most common fracture, the Salter-Harris I fracture of the distal fibula, may be diminished. Our ability to make this clinical diagnosis with confidence may thus be compromised.
• •9. Recent history of surgery or closed reduction of the same ankle within the last 3 months. These prior events may confuse current presenting symptomatology and ability to weight-bear and recover normally.
• •10. Patients with low risk injuries who do not have phone or electronic mail access and/or have an insurmountable language barrier. This will preclude follow up.