1Senior Resident, Dept. of Orthopedics, IGIMS, Patna
2Lecturer, Dept. of Orthopedics, IOM, Kathmandu, Nepal
3Associate Professor, Dept. of Orthopedics, IOM, Kathmandu, Nepal
4Prof & Ex-HOD, Dept. of Orthopedics, IOM, Director IOM, Kathmandu, Nepal
*Corresponding author: Dr. Nishant Kashyap, Senior Resident, Dept. of Orthopedics, IGIMS, Patna, Ph: -+91 7070808787. E.mail: jhini98@gmail.com
Online published on 10 February, 2017.
To evaluate the accuracy of “Ottawa knee rule’’ for predicting clinically significant fracture in acute knee injuries and to assess the potential of these tests to reduce unnecessary x-ray.
Acute knee injuries are common presenting complaint of patients seen in emergency department, but only a small percentage of patients, approximately 6% have clinically significant fractures. However, these patients are almost always referred for radiography. The Ottawa knee rule provides guidance on how to identify which cases of knee injury require radiographic investigation.
This prospective study was done in emergency and OPD, Orthopedics department of Tribhuvan University Teaching Hospital during January 2012 to September 2013 over 20 months. Ninety two patients were included in this study. All eligible patients were assessed for standardized clinical variables and the need for radiography was determined according to the OKRs.
Ottawa knee rules 12, 13 Order radiography of the knee if any of the following factors are present:
Age 55 years or older
Tenderness at head of fibula
Isolated tenderness of patella
Inability to flex knee to 90 degrees
Inability to walk four weight-bearing steps immediately after the injury and in emergency department Radiography was performed in each patient, irrespective of the determination of the rule, after the clinical evaluation findings were recorded. The rule was assessed for the ability to correctly identify the fracture around the knee.
The “Ottawa Knee Rule’’ had a sensitivity of 1.0(95% confidence interval 0.80 to 1), identifying 21 patients with clinically important fractures. The potential reduction in use of radiography was estimated to be 29.34%. The probability of fracture, if the decision rule were negative, was estimated to be 0%.
Prospective validation has shown the Ottawa Knee Rules to be 100% sensitive for identifying fractures of the knee and to have the potential to allow physician to reduce the use of radiography in patients with acute knee injuries.
Fracture, Knee joints, Ottawa Knee Rule, X-ray
