The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle, and that the decision to obtain radiographs is dependent on the exam and Diane's description of her injury. Which of the following clues in Diane's exam or history would alert the clinician to the need for obtaining radiographs? a. Inability to bear weight immediately after the injury
b. Development of marked ankle swelling and discoloration after the injury
c. Crepitation with palpation or movement of the ankle
d. All of the above

d. All of the above.

Explanation:

There are a set of rules that help the clinician to determine if the patient needs X-rays, these rules are the Ottawa ankle rules, and they state that a patient with pain in the ankle may need radiography if he or she has any of the following symptoms: pain in the malleolar zone, bone tenderness on the tip lateral or the posterior edge of the medial malleolus, the one of the tibia, bone tenderness on the posterior edge or tip of the lateral malleolus, the one of the fibula, and lastly inability to bear weight on the injured ankle immediately and in the emergency department for a total of four steps.

If Diane has any of these symptoms, she qualifies for X-rays. Otherwise, they will not be of great use, and it will expose her to an unnecessary dose of radiation.

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