BACKGROUND: Foot and ankle injuries are frequent in emergency departments. 
Although only a few patients with foot and ankle sprain present fractures and 
the fracture patterns are almost always simple, lack of fracture diagnosis can 
lead to poor functional outcomes.
AIM: The present study aims to evaluate the reliability of the Ottawa ankle 
rules and the orthopedic surgeon subjective perception to assess foot and ankle 
fractures after sprains.
SUBJECTS AND METHODS: A cross-sectional study was conducted from July 2012 to 
December 2012. Ethical approval was granted. Two hundred seventy-four adult 
patients admitted to the emergency department with foot and/or ankle sprain were 
evaluated by an orthopedic surgeon who completed a questionnaire prior to 
radiographic assessment. The Ottawa ankle rules and subjective perception of 
foot and/or ankle fractures were evaluated on the questionnaire.
RESULTS: Thirteen percent (36/274) patients presented fracture. Orthopedic 
surgeon subjective analysis showed 55.6% sensitivity, 90.1% specificity, 46.5% 
positive predictive value and 92.9% negative predictive value. The general 
orthopedic surgeon opinion accuracy was 85.4%. The Ottawa ankle rules presented 
97.2% sensitivity, 7.8% specificity, 13.9% positive predictive value, 95% 
negative predictive value and 19.9% accuracy respectively. Weight-bearing 
inability was the Ottawa ankle rule item that presented the highest reliability, 
69.4% sensitivity, 61.6% specificity, 63.1% accuracy, 21.9% positive predictive 
value and 93% negative predictive value respectively.
CONCLUSION: The Ottawa ankle rules showed high reliability for deciding when to 
take radiographs in foot and/or ankle sprains. Weight-bearing inability was the 
most important isolated item to predict fracture presence. Orthopedic surgeon 
subjective analysis to predict fracture possibility showed a high specificity 
rate, representing a confident method to exclude unnecessary radiographic exams.