Ankle Injury Using the Ottawa Rules - Essay Example

Ankle Injury Using the Ottawa Rules Introduction Ankle sprain injuries are a common sight in many hospitals. People, especially athletes, normally have such injuries when they are busy training. Whenever they have such sprains, most of them take a radiography test to determine the extent of the sprain. In most cases, the test result comes out negative whereby no fracture of the bones occurred. According to research conducted in a number of hospitals, about 5% of all patients that visit hospitals in a single day normally have ankle injuries but only 15 % of these patients have bone fractures (Bessen et al., 2009). Apart from adults, children too are victims of ankle injuries where many of them acquire the injuries while they are playing or dancing (Steinberg et al., 2014). Whereas many people believe in radiography tests because of its accuracy in detecting fractures, it is of great importance that one seeks such treatment from qualified clinicians. This is because much research conducted on radiography proves that frequent use and high dosage of radiation normally result to health complications where one could contact chronic diseases such as cancer (Gyekye et al., 2013). However, in 1992, the University of Ottawa in Canada came with a solution whereby instead of taking the expensive radiography tests, it was possible to determine the state of the leg or ankle through a few techniques and procedures (Welling, 2012, p. 2). The Ottawa ankle rules include the use of assessments to identify the state of a patient’s injury. In the physical assessment, the clinical practitioner asks the patient to perform a number of movements in order to make proper diagnosis and determine the type of medication that one requires. Some of the assessments the patient undergoes include the ankle and mid-foot assessment. In the ankle assessment, the patient needs to take few steps to enable the doctor take note of how tender the posterior edge has become (Magee, 2014, p. 981). Conversely, the mid-foot analysis, the clinician takes notes on the stability of the nerves. Many hospitals in the United Kingdom are embracing this method because apart from being effective, it is also cheaper when compared to previous methods where one had to undergo a radiography test before a diagnosis or medication is made. The essay will not only provide more information on the Ottawa ankle rules but also how their introduction has been of great benefit to many people not only in the UK but globally. Rationale The reason for the topic is there have been a high number of patients who normally spend a lot of time in the emergency room undergoing radiography tests only to discover that they do not have any fractures, rather only minor sprains. It is because of this reason that the Ottawa ankle rules came into existence. According to research, the main reason behind the introduction of the Ottawa rules was to prevent unnecessary radiographs that come to emergency rooms with ankle and foot injuries (Bessen et al., 2009). Many benefits have resulted from the use of these rules. Apart from a decline in the number of radiographs, the process has also resulted to more satisfaction among patients because unlike radiographs, assessments tests are faster hence not time consuming. In addition, the research intends to attain adequate, valid and up to date information concerning this research’s focus that will not only beneficial to the practice but also to the researcher. On the part of practice, this compiled report will act as a reference meant to avail emergent, valid and adequate information featuring advancements made in the medical field. This towards both managing and treatment of ankle related injuries and the best method that is acceptable by all patients, whether they have funds worth radiography or not. Although the Ottawa ankle rule has been proven to be effective, some people still prefer the radiography test even after the Ottawa rule has been performed on them and it has been revealed to them that a radiograph test will not be necessary (Newman, 2009, p. 80). According to many clinical practitioners, most patients prefer the radiography test compared to the Ottawa rule. Although the rule was initially developed only for adults, further research have proved that the method can also be applied on children (Newman, 2009).Determining whether the patient needs to undergo a radiography test, physicians are trained fully trained on the Ottawa Ankle rule how to detect the sign on a possible fracture. For instance, if the patient is not able to bear weight when the physician asks him to make four steps, this is normally a clear indication of fracture and needs further checking; such a patient needs to take a radiograph test (Starkey et al., 2010). Apart from the inability to bear weight, a radiograph test is necessary if the physician experiences tenderness on the navicular bone section during examination. The research will stress on the Ottawa ankle rules developed by the University of Ottawa and since its release, the rules have been accepted by many nations around the globe for not only its cost effectiveness but also its sensitivity in conducting ankle and feet assessment test. Literature Review Studies so far on research conducted have confirmed Ottawa Ankle rules are more effective and cost effective compared to the traditional conventional methods used to detect fractures (Fetters & Tilson, 2012, p. 71). This is because a clinical personnel whereby in this case is a nurse usually embarks on utilizing physical means to ascertain both the extent of ankle’s injury as well as if the patient entails further checkups. This is before resulting to radiographs, which are more expensive when it comes to predicting the condition of a given patient. Hence, save the hospital much expense (Fetters & Tilson, 2012). On the part of patient, this is helpful because one will not have to undergo unnecessary exposure of radiograph radiations commonly known to be carcinogenic. This implies those who have to undergo radiograph tests are the ones nurses have ascertained beyond doubt they experience serious injuries or fractures (Fetters & Tilson, 2012, p. 71). Hence, entailing careful medical attention that will rectify their varied conditions as necessitated without having to undergo trial and errors of radiations, which is extremely detrimental when exposed to a patient for a prolonged period. Based on Fetters and Tilson’s (2012) study, use of Ottawa ankle rules help in avoid much time spent in emergency rooms as well as patient’s dissatisfaction. There earlier contrary to the present, hospitals used to incur many expenses in using radiograph as the sole and effective mode of detecting fractures. This is because in the process clinicians ended up erring and missing essential information concerning the extent of fractures of a given patient. The current rules emphasize mostly on physical examination whereby through pain one is cable of knowing exactly where the patient complains of much pain (Fetters & Tilson, 2012, p. 71). Therefore, clinicians by use of Ottawa Ankle rules will end up reducing much healthcare expenses besides ensuring patients’ satisfaction. Bope and Kellerman (2013) in their study contend Ottawa ankle rules compared to traditional conventional radiograph aid in making appropriate decisions on how to both manage and treat injuries sustained by the patient. Therefore, nurses or clinicians only apply radiography when the patient does not pass the Ottawa rules as required. Some of the rules that require a patient to pass include walking more than for steps immediately after the injury or after arriving at the emergency room (Bope & Kellerman, 2013, p. 567). Apart from walking for steps, the patient ought to be younger than 55 years of age, this is because at this age, the patient is normally old and fragile hence such physical exercises will end up doing more harm than good to the patient (Bope & Kellerman, 2013). After the application of the Ottawa ankle rules, the final findings noted by the clinical practitioners normally determine whether the patient will proceed to the radiography test or he will just receive other forms of medication. When the final results are positive, this is usually indication that there is a possibility that the patient has obtained a fracture, the next step is normally asking the patient to conduct a radiography test in order to identify exactly where the fracture has occurred. After a successful radiograph test, the patient, a diagnosis is made depending on the nature of the fracture (Bope & Kellerman, 2013). Whereas radiography tests produce the best results, there is need for caution because not all tests conducted via radiograph are correct (Wolfson & Hendey, 2010, p. 254). After radiography test, one gets a film showing the image of the fractured section. If the radiography film is not clear enough to show the image, this is normally a sign that the test was not a success hence this calls for another radiography and could be very expensive especially if one is not financially stable (Wolfson & Hendey, 2010, p. 254). Patients are always advised not to accept films that are of poor quality because this is not only an indication of unskilled clinicians but also this normally results to misdiagnosis where some fractures are not detected . Lack of proper diagnosis normally results to poor medication where one receives treatment for an illness that one is not suffering from, this could be fatal if no adequate measures are taken. Apart from poor quality radiograph, other errors that come because of radiography include not detecting all fractured bones by only focusing on one section where the patient is complaining the most. For instance, when one falls down from the stairs, there is normally a possibility of multiple fractures but because the radiograph only one section at a time, there is a high possibility that some fractures will go undetected. This usually results to leaving the hospital with undetected fractures that will continue hurting him until he seeks further treatment elsewhere (Wolfson & Hendey, 2010, p. 256). Whereas many people still believe that the Ottawa ankle rule is only for people above 18 years of age, research states that children are also in a position to perform the test. The test has no adverse effect on children; instead, it is capable of safely reducing radiography among kids that have ankle injuries (Blackham, Claridge & Benger, 2008). During the assessment, clinical practitioners normally conduct a number of observations. For instance, apart from the four steps that are mandatory, nurses also make record of whether the patient has had such injuries in the past and what were the medical prescriptions. The nurses also enquire on the patient’s activity changes as well as the chronicity (Sloane, 2008, p. 544). Other symptoms that require checking include the inability of the patient to bear weight and the feeling that the ankle feels like it has dislocated. These two symptoms are usually worrisome hence require proper attention. This is because unlike other symptoms, they are usually the determinants if the patient has obtained a fracture and is need of immediate medical attention or it is just an ankle sprain (Sloane, 2008). One thing that makes the Ottawa ankle rule unique is the fact that unlike radiography tests that require one to visit the nearest hospital, the Ottawa ankle rule is easy to perform and can even be done at home (Blackham, Claridge & Benger, 2008, p. 750). One can distinguish between a fracture and a sprain by simply palpating the metatarsal and the malleolus. By gently palpating these sections, one will be in a position to locate the point of injury just by how the patient will react after feeling the affected area (Blackham, Claridge & Benger, 2008). Ankle sprains are classified into three sections: grades I and II are normally less severe and usually heal faster compared to grade III that could take 6-8 weeks (Sloane, 2008, p. 547). Grade 1 is normally associated with minor tearing or stretching of ligaments or muscles that normally result to a slight swell around the affected area such as lateral malleolus and normally result to some walking difficulties because of joint stiffness or pain. Grade 1 type of strain is easily manageable such that it can heal in a matter of hours (Welling, 2012, p. 26). Grade 2 type of sprain normally comprises tearing of ligament, and compared to Grade I, it is more painful because of the joint stiffness and bruise. Unlike Grades 1 and 2, Grade 3 is more painful and severe. Its symptoms include total rapture of the ligaments and tendons that result to ankle joint instability hence difficulty in walking (Welling, 2012). The most common medication of ankle sprain injuries is normally NSAID, the drug is mostly recommended because of its inflammation reducing ability (Sloane, 2008). Unlike ankle sprains that are treatable from home, ankle fractures need to seek medical attention from a clinical practitioner. This is because whereas sprains can heal from home through proper medication, fractures need examination by a clinical practitioner to determine the extent of the fracture (Sloane, 2008). In hospital, clinicians normally ask a number of questions before prescribing medication. This is because, a professional clinician ought to know the history of the patient so that he is more informed on when the injury occurred, the symptoms that the patient experienced and what first aid procedures were performed to the patient (Welling, 2012, p. 19). Common processes that clinical practitioners implement during the Ottawa ankle rule assessment include the touch, feel and move policy (Welling, 2012, p. 20). In the looking stage, clinicians compare both the injured and non-injured sides of the ankle to identify the difference so that they are in a position to know the degree of the injury. In the feel and touch stages, the clinician palpates the injured area and assesses it in a move to see if there are other potential injures that should not go unnoticed(Welling, 2012, p. 20). Unlike the Ottawa ankle rule, radiography tests normally come with a number of issues. According to research conducted, frequent application of radiography to patients normally results in cancer related complications (Gyekye et al., 2013). This usually occurs because during radiography, there is high exposure of radiation waves that are harmful to humans if not controlled properly. Apart from causing cancer, the radiations are also harmful to pregnant women because they can result to birth problems such as miscarriages or giving birth to children with health related issues such as chest problems (Lowe, 2004). Implications The main aim of the study is to ensure that clinical practitioners are fully qualified before conducting the Ottawa Ankle rules on patients. Hospital managements should also make sure that its clinical practitioners get recent updates on the Ottawa rules by hosting medical seminars where clinicians are likely to obtain more skills on handling various types of injuries. The management should also ensure that junior clinicians do not assess patients on their own, unless there is a senior clinician present to guide him. Information provided in the study will be of great help to junior clinicians and medical students because apart from the detailed information on Ottawa ankle rules that will be of great help, the study will also aid in the implementation of the three main medical policies of clinical practitioners that is the touch, feel and move. Future studies should provide more information on how Ottawa ankle rules are implementable from home just in case one cannot access a hospital in time. Conclusion In the past, clinical practitioners normally recommended that all ankle injuries undergo radiography tests. According to research, in all ankle radiography tests conducted on patients, only 15 % were positive, which implies that 85% did not have fractures as earlier stated. The radiography test had several disadvantages. For instance, patients spending a lot of time in the emergency room only for the test to come out negative was not only disturbing but also demoralising. Apart from the process being time consuming, it normally exposed patients to radiation, which made them vulnerable to contracting cancer related diseases. In 1992, the University of Ottawa in Canada introduced the Ottawa ankle rules. Unlike radiography tests, these rules were only required for physical assessment where by implementing the three clinician policies of touch, feel and move, clinicians are in a position to verify whether the patient has a fracture or a sprain. References Bessen, T, Clark, R, Shakib, S, & Hughes, G 2009, Quality improvement report: a multifaceted strategy for implementation of the Ottawa ankle rules in two emergency departments, British Medical Journal, vol. 7717, p. 396, JSTOR Life Sciences, EBSCOhost, viewed 21 March 2014. Blackham, J, Claridge, T, & Benger, J 2008, Can patients apply the Ottawa ankle rules to themselves?’ Emergency Medicine Journal, vol. 25, no. 11, pp. 750-751, MEDLINE, EBSCO host, viewed 21 March 2014. Bope, ET & Kellerman, RD 2013, Conns current therapy 2013: latest approved methods of treatment for the practicing physician, Elsevier Saunders, Philadelphia, PA. Fetters, L & Tilson, J 2012, Evidence based physical therapy, F. A. Davis Company, Philadelphia. 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