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Validação das regras de ottawa para traumatismos do tornozelo, na população pediatrica em portugal

Patrícia Rodrigues, João Lameiras Campagnolo, Susana Norte Ramos, Delfin Tavares

Serviço de Ortopedia Pediátrica do Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa

- Apresentação no 35º Congresso Nacional de Ortopedia e Traumatologia, em Outubro 2015 no Porto.

Introduction - Injuries of ankle and foot are a major cause of displacement of children to the emergency room.  Although only 12 to 20% of cases presenting relevant fractures, almost all children do x-ray in the emergency department. The various studies conducted in the evaluation of the rules of Ottawa for injuries of ankle and foot, in adults, showed a sensitivity of 100%, resulting in a significant reduction in the number of x-ray performed. The ankle and foot injuries in children, have special characteristics. Ligament inserts are distal to the growth plate, and sprains can lead to epiphysiolysis  with varying degrees of severity. Also the clinical evaluation of the child may be hampered by their communication skills and psychological factors such as anxiety and pain tolerance. This study aims to verify that you can use the Ottawa rules on the evaluation of foot and ankle trauma in children.
Methods - It is a prospective study that took place in Orthopedics Emergency Department, during the period of 6 months. The study included all patients aged between 3 and 18 years, who presented with complaints in the ankle and / or foot with less than 48 hours of evolution. We excluded from the study patients with the following criteria: recent fracture of the ankle / foot, neurological impairment, developmental delay, metabolic bone disease, multiple trauma, analgesia history in 6 hours prior to the presence in the emergency department, recent surgery to the ankle / foot (<6months) , altered level of consciousness - GCS <15/15. All patients underwent X-rays of the ankle and / or foot (anteroposterior and lateral), depending on the location of complaints. X-rays were evaluated by orthopedists. All orthopedists filled out a form for each patient. Patients were reassessed in consultation two weeks after the injury, always by the same doctor (the author of the study).
Results - We evaluated 154 patients (81 female and 72 male) with a mean age of 11.3 (between 3 and 18). Of the 154 patients evaluated, 94 had positive criteria for radiological assessment, of which 28 had fractures; 33 had negative criteria and there were no fracture. The sensitivity of Ottawa rules to detect fracture was 100% and the specificity was 26%.