Broken Ankle or Ankle Sprain?
Benjamin C. Wedro, MD, FACEP, FAAEM
Medical Editor: Charles P. Davis, MD, PhD
The difference between doctors who look after mere mortals and those who look after elite athletes may have to do with how many tests they can order, regardless of the cost. And when X-ray and MRI reports lead the news, it makes it difficult for family doctors to explain why those tests aren't necessarily appropriate for them (or even the elite athlete).
Ankle sprains are common injuries and historically, patients expected that if they went to the ER or their doctor's office, they would have an X-ray taken to prove there were no broken bones. As it turns out, the vast majority of those ankle X-rays done were normal and, in retrospect, could be seen as expensive, wasteful, and posed another opportunity to expose a person to unneeded radiation. Ian Stiell and his colleagues in Ottawa, Canada completed a study that showed it was not useful to order all those tests, since less than 15% of those ankle X-rays were positive for a fracture. The results of the study also allowed Dr. Stiell to develop the Ottawa ankle rule guidelines. They give the doctor and the patient a starting point for the discussion about care and treatment for ankle injuries.