CLINICAL-EVALUATION OF ANKLE INVERSION INJURIES IN FAMILY-PRACTICE OFFICES

Background. The use of radiography in evaluating inversion ankle injur ies remains high despite several studies suggesting that x-ray examina tion should be limited to patients meeting certain clinical criteria. These studies were all done in emergency departments. The present stud y examined detection of ankle fractures by clinical evaluation alone i n private family practice offices. Methods. Twelve physicians in three family practice offices participated. Check-off forms were developed to record clinical data. The physicians all attended a session to stan dardize terminology. The physicians then evaluated 94 consecutive pati ents with inversion ankle injuries. Results. Eight fractures were dete cted by radiography, five of which had not been suspected on clinical examination (5.9% false-negative rate). Only one fracture required tre atment different from that for a sprain. Tenderness on the dorsum of t he foot, impaired weight-bearing ability, recentness of injury (less t han 12 hours earlier), and presence of additional injuries were signif icantly associated with a fracture. Unlike several previous studies, s welling was not associated with fractures. If radiography had been lim ited to patients presenting with inability to bear weight fully or ten derness on the dorsum of the foot, none of the fractures would have be en missed, and the use of radiography would have been reduced from 90% to 61%. Conclusions. The fracture rate in these family practice offic es is lower than that reported in most emergency department studies. I t is important that family physicians order radiographs judiciously ra ther than routinely for patients with inversion ankle injuries. The cl inical criteria reported here are likely to reduce unnecessary orderin g of radiographs and are compatible with recently published, prospecti vely validated rules for acute ankle injury in an emergency department setting.