Radiographic Evaluation

The Ottawa Knee Rules (Tabi®.266.-1) for determining the need for x-rays have proven sensitive for fracture1 and have resulted in reduced emergency department waiting times and costs. The Pittsburgh Knee Rules (T§M§...,2,6.6i2,) are similar and recently were prospectively shown to be as sensitive, but more specific than the Ottawa Rules.2 They also have the added advantage of being applicable to both children and adults. A recent evaluation 3 suggested that point tenderness is not a good predictor of knee fracture in children. This study suggested that applying a rule of an inability to bear weight and inability to flex the knee to 90° would decrease x-rays ordered by 75 percent without any missed fractures.

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1. k' L'iiliiintsI [TJK aiiiil t IrattliyiobbcciQWVtnn

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TABLE 266-1 Ottawa Knee Rules: Guidelines for X-Ray

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