{"id":11499,"date":"2022-08-18T15:33:41","date_gmt":"2022-08-18T13:33:41","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=wiki&amp;p=11499"},"modified":"2022-08-18T15:33:41","modified_gmt":"2022-08-18T13:33:41","slug":"malleolar-zone-algorithm","status":"publish","type":"wiki","link":"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/","title":{"rendered":"Malleolar Zone Algorithm"},"featured_media":11500,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":""},"class_list":["post-11499","wiki","type-wiki","status-publish","has-post-thumbnail","hentry"],"acf":{"free_access":"","app_link":"","sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":11500,"background_image_alt_text":"Malleolar Zone Algorithm | Malleolus Fracture Assessment in Children"},"heading":"Malleolar Zone Algorithm","subheading":"Screening","content_editor":"","button_type":"internal_link","button_label":"Check our shop","button_style":"button-five","button_internal_link":"","button_anchor":"","button_url":"","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Learn","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Assessment E-Book","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Reviews","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":16662,"button_anchor":"","button_url":"","button_file":""},"button_description":"Find this wiki on the Physiotutors platform"},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>Learn<\/h4>"},"column_right":{"content_editor":"<h6>Malleolar Zone Algorithm | Malleolus Fracture Assessment in Children<\/h2>\n<span style=\"font-weight: 400;\">The malleolar zone algorithm was developed by <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15231460\/\" target=\"_blank\" rel=\"noopener\">Dayan et al. (2004)<\/a>. Their goal was to develop a maximally sensitive clinical prediction rule to identify fractures after ankle injuries in children younger than 18 years of age. This includes fractures of the tibia, fibula, or talus.<\/span>\n\n<span style=\"font-weight: 400;\">They argue the importance of such a new CPR as validation studies of the Ottawa Ankle Rules in a population of children resulted in conflicting results.<\/span>\n\n<span style=\"font-weight: 400;\">A recent systematic review by <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28764972\/\" target=\"_blank\" rel=\"noopener\">Barelds et al. (2017)<\/a> pooled the results of three studies investigating the malleolar zone algorithm and reports a positive likelihood ratio of 1.24 and a negative likelihood ratio of 0.23 and in our opinion, it has a moderate clinical value.\u00a0<\/span>\n<div class=\"embed-container\">\n\n[embed]https:\/\/www.youtube.com\/watch?v=UM5GGgtk8r0[\/embed]\n\n<\/div>\n<span style=\"font-weight: 400;\">The malleolar zone algorithm goes as follows and aims to identify significant or high-risk fractures in children younger than 18 years of age after an acute twisting ankle injury.<\/span>\n\n<span style=\"font-weight: 400;\">First, you will check for tenderness in any area of the lateral or medial malleolus.\u00a0<\/span>\n\n<span style=\"font-weight: 400;\">In case the first step is negative, assess whether the fibula is tender just proximal to the malleolus. If that is the case, there\u2019s a high risk of fracture.<\/span>\n\n<span style=\"font-weight: 400;\">If you found tenderness over the malleolus during the first step, check if the child is able to walk 4 steps. If the child is unable to do so, there is a high risk of fracture.<\/span>\n\n<span style=\"font-weight: 400;\">If the child is able to walk four steps but there is swelling over the lateral or medial malleolus then there is again a high risk for fracture, which would warrant radiographic investigation.<\/span>\n\n&nbsp;\n\n[cta]\n\n&nbsp;\n\nOther common tests to screen for ankle fractures are:\n\n<a href=\"https:\/\/www.physiotutors.com\/wiki\/bernese-ankle-rules\/\">Bernese Ankle Rules<\/a>\n\n<a href=\"https:\/\/www.physiotutors.com\/wiki\/midfoot-zone-algorithm\/\">Midfoot Zone Algorithm<\/a>\n\n<a href=\"https:\/\/www.physiotutors.com\/wiki\/low-risk-ankle-rule\/\">Low Risk Ankle Rule<\/a>\n\n<a href=\"https:\/\/www.physiotutors.com\/wiki\/ottawa-ankle-rules\/\">Ottawa Ankle Rules<\/a>\n\n&nbsp;\n"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>References<\/h4>"},"column_right":{"content_editor":"<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15231460\/\" target=\"_blank\" rel=\"noopener\">Dayan, P. S., Vitale, M., Langsam, D. J., Ruzal\u2010Shapiro, C., Novick, M. K., Kuppermann, N., &amp; Miller, S. Z. (2004). Derivation of clinical prediction rules to identify children with fractures after twisting injuries of the ankle.\u00a0<i>Academic emergency medicine<\/i>,\u00a0<i>11<\/i>(7), 736-743.<\/a>\n\n<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28764972\/\" target=\"_blank\" rel=\"noopener\">Barelds, I., Krijnen, W. P., van de Leur, J. P., van der Schans, C. P., &amp; Goddard, R. J. (2017). Diagnostic accuracy of clinical decision rules to exclude fractures in acute ankle injuries: systematic review and meta-analysis.\u00a0<i>The Journal of emergency medicine<\/i>,\u00a0<i>53<\/i>(3), 353-368.<\/a>"}},{"acf_fc_layout":"cta-image-v2","layout":"","background":"transparent","heading":"","content_editor":"<p class=\"subheading\">Like what you\u2019re learning?<\/p>\n<p class=\"heading-two\">BUY THE FULL PHYSIOTUTORS <strong>ASSESSMENT BOOK<\/strong><\/p>\n\n<ul>\n \t<li>600+ Pages e-Book<\/li>\n \t<li>Interactive Content (Direct Video Demonstration, PubMed articles)<\/li>\n \t<li>Statistical Values for all Special Tests from the latest research<\/li>\n \t<li>Available in \ud83c\uddec\ud83c\udde7 \ud83c\udde9\ud83c\uddea \ud83c\uddeb\ud83c\uddf7 \ud83c\uddea\ud83c\uddf8 \ud83c\uddee\ud83c\uddf9 \ud83c\uddf5\ud83c\uddf9 \ud83c\uddf9\ud83c\uddf7<\/li>\n \t<li>And much more!<\/li>\n<\/ul>","button_type":"internal_link","button_label":"Check out our shop","button_style":"button-two","button_internal_link":4464,"button_anchor":"","button_url":"","button_file":null,"side_button":{"side_button_content_editor":""},"bottom_button":{"bottom_button_content_editor":""},"image":22705,"image_alt_text":""},{"acf_fc_layout":"review-slider","heading":"WHAT CUSTOMERS HAVE TO SAY ABOUT THE ASSESSMENT E-BOOK","image_shortcode":"","image":"","image_alt_text":"","shortcode":"[wprevpro_usetemplate tid=\"2\"]","button_type":"internal_link","button_label":"","button_style":"button-one","button_internal_link":"","button_anchor":"","button_url":"","button_file":null},{"acf_fc_layout":"cta-full-width-v2","logo":{"logo_image":22443,"logo_image_alt_text":""},"heading":"<strong>Download<\/strong> the free Physiotutors app now!","content_editor":"","download_image":{"download_image_image":22444,"download_image_image_alt_text":""},"mobile_download_image":{"mobile_download_image_image":22445,"mobile_download_image_image_alt_text":""},"download_image_link":"https:\/\/onelink.to\/6dtzk5","mockup_image":{"mockup_image_image":22447,"mockup_image_image_alt_text":""},"mobile_mockup_image":{"mobile_mockup_image_image":22446,"mobile_mockup_image_image_alt_text":""}}]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Malleolar Zone Algorithm | Malleolus Fracture Assessment in Children<\/title>\n<meta name=\"description\" content=\"The Malleolar Zone Algorithm is a prediction rule to exclude fractures of the malleolus region in children with acute ankle injuries.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Malleolar Zone Algorithm | Malleolus Fracture Assessment in Children\" \/>\n<meta property=\"og:description\" content=\"The Malleolar Zone Algorithm is a prediction rule to exclude fractures of the malleolus region in children with acute ankle injuries.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/\" \/>\n<meta property=\"og:site_name\" content=\"Physiotutors\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/facebook.com\/physiotutors\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/08\/screening_malleolarzonealgorithm_1.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1920\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@physiotutors\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/wiki\\\/malleolar-zone-algorithm\\\/\",\"url\":\"https:\\\/\\\/www.physiotutors.com\\\/wiki\\\/malleolar-zone-algorithm\\\/\",\"name\":\"Malleolar Zone Algorithm | Malleolus Fracture Assessment in Children\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/wiki\\\/malleolar-zone-algorithm\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/wiki\\\/malleolar-zone-algorithm\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.physiotutors.com\\\/wp-content\\\/uploads\\\/2022\\\/08\\\/screening_malleolarzonealgorithm_1.jpg\",\"datePublished\":\"2022-08-18T13:33:41+00:00\",\"description\":\"The Malleolar Zone Algorithm is a prediction rule to exclude fractures of the malleolus region in children with acute ankle injuries.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/wiki\\\/malleolar-zone-algorithm\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.physiotutors.com\\\/wiki\\\/malleolar-zone-algorithm\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/wiki\\\/malleolar-zone-algorithm\\\/#primaryimage\",\"url\":\"https:\\\/\\\/www.physiotutors.com\\\/wp-content\\\/uploads\\\/2022\\\/08\\\/screening_malleolarzonealgorithm_1.jpg\",\"contentUrl\":\"https:\\\/\\\/www.physiotutors.com\\\/wp-content\\\/uploads\\\/2022\\\/08\\\/screening_malleolarzonealgorithm_1.jpg\",\"width\":1920,\"height\":1080,\"caption\":\"Malleolar Zone Algorithm\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/wiki\\\/malleolar-zone-algorithm\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.physiotutors.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Malleolar Zone Algorithm\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/#website\",\"url\":\"https:\\\/\\\/www.physiotutors.com\\\/\",\"name\":\"Physiotutors\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.physiotutors.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/#organization\",\"name\":\"Physiotutors\",\"url\":\"https:\\\/\\\/www.physiotutors.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/www.physiotutors.com\\\/wp-content\\\/uploads\\\/2021\\\/06\\\/PHY_Logo-Purple-2.svg\",\"contentUrl\":\"https:\\\/\\\/www.physiotutors.com\\\/wp-content\\\/uploads\\\/2021\\\/06\\\/PHY_Logo-Purple-2.svg\",\"width\":315,\"height\":65,\"caption\":\"Physiotutors\"},\"image\":{\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/facebook.com\\\/physiotutors\",\"https:\\\/\\\/x.com\\\/physiotutors\",\"https:\\\/\\\/instagram.com\\\/physiotutors\",\"https:\\\/\\\/youtube.com\\\/physiotutors\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Malleolar Zone Algorithm | Malleolus Fracture Assessment in Children","description":"The Malleolar Zone Algorithm is a prediction rule to exclude fractures of the malleolus region in children with acute ankle injuries.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/","og_locale":"en_US","og_type":"article","og_title":"Malleolar Zone Algorithm | Malleolus Fracture Assessment in Children","og_description":"The Malleolar Zone Algorithm is a prediction rule to exclude fractures of the malleolus region in children with acute ankle injuries.","og_url":"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/","og_site_name":"Physiotutors","article_publisher":"https:\/\/facebook.com\/physiotutors","og_image":[{"width":1920,"height":1080,"url":"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/08\/screening_malleolarzonealgorithm_1.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","twitter_site":"@physiotutors","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/","url":"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/","name":"Malleolar Zone Algorithm | Malleolus Fracture Assessment in Children","isPartOf":{"@id":"https:\/\/www.physiotutors.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/#primaryimage"},"image":{"@id":"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/#primaryimage"},"thumbnailUrl":"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/08\/screening_malleolarzonealgorithm_1.jpg","datePublished":"2022-08-18T13:33:41+00:00","description":"The Malleolar Zone Algorithm is a prediction rule to exclude fractures of the malleolus region in children with acute ankle injuries.","breadcrumb":{"@id":"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/#primaryimage","url":"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/08\/screening_malleolarzonealgorithm_1.jpg","contentUrl":"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/08\/screening_malleolarzonealgorithm_1.jpg","width":1920,"height":1080,"caption":"Malleolar Zone Algorithm"},{"@type":"BreadcrumbList","@id":"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.physiotutors.com\/"},{"@type":"ListItem","position":2,"name":"Malleolar Zone Algorithm"}]},{"@type":"WebSite","@id":"https:\/\/www.physiotutors.com\/#website","url":"https:\/\/www.physiotutors.com\/","name":"Physiotutors","description":"","publisher":{"@id":"https:\/\/www.physiotutors.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.physiotutors.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/www.physiotutors.com\/#organization","name":"Physiotutors","url":"https:\/\/www.physiotutors.com\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.physiotutors.com\/#\/schema\/logo\/image\/","url":"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2021\/06\/PHY_Logo-Purple-2.svg","contentUrl":"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2021\/06\/PHY_Logo-Purple-2.svg","width":315,"height":65,"caption":"Physiotutors"},"image":{"@id":"https:\/\/www.physiotutors.com\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/facebook.com\/physiotutors","https:\/\/x.com\/physiotutors","https:\/\/instagram.com\/physiotutors","https:\/\/youtube.com\/physiotutors"]}]}},"_links":{"self":[{"href":"https:\/\/www.physiotutors.com\/wp-json\/wp\/v2\/wiki\/11499","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.physiotutors.com\/wp-json\/wp\/v2\/wiki"}],"about":[{"href":"https:\/\/www.physiotutors.com\/wp-json\/wp\/v2\/types\/wiki"}],"version-history":[{"count":0,"href":"https:\/\/www.physiotutors.com\/wp-json\/wp\/v2\/wiki\/11499\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.physiotutors.com\/wp-json\/wp\/v2\/media\/11500"}],"wp:attachment":[{"href":"https:\/\/www.physiotutors.com\/wp-json\/wp\/v2\/media?parent=11499"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}