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Solomon Sallfors
Considering a fracture, guided by Ottawa rules for ankle X-Rays, both for single x-ray and x-ray series
(standard AP, mortise AP, and lateral).
Figure 1. Ottawa ankle rules. Adapted from Stiell IG, et al. Implementation of the Ottawa ankle rules. JAMA 1994; 271: 82732.
Treatment: Functional treatment preferred over immobilization and usually consists of three phases: (1) the
PRICE protocol is initiated within 24 hours of injury to minimize pain and swelling and limit the spread of
injury; (2) exercises to restore motion and strength usually begin within 48 to 72 hours of injury (see
accompanying patient handout for exercise descriptions); and (3) endurance training, sport-specific drills, and
training to improve balance begin when the second phase is well underway.1
Reexamination three to five days after injury
Lateral ligament sprains:
Grade I: Ligament integrity, minimal swelling, conservative care: brace, ice, avoid pain, weight-bearing allowed
Grade II: slight laxity, Goose egg swelling, protected weight-bearing w/ weight-bearing exercise in 2 wks
Grade III Complete rupture, Immediate diffuse swelling, heard pop, immobilized in removable walking cast
3-4wks; rehab, and surgery (esp. for elite athletes); reconstruct if fxnl ligament instability.
mortise
1 Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly KD, Struijs PA, van Dijk CN. Immobilisation for acute ankle sprain. A systematic review. Arch Orthop Trauma Surg. 2001;121:46271.