

The Low Risk Ankle Rules is an ankle decision rule that is developed specifically for ankle injuries in children below the age of 16 as a screening tool for high-risk fractures that would warrant radiographic exploration versus low-risk injuries that don’t. The definition of low-risk injuries includes lateral ankle sprains, nondisplaced Salter-Harris type I and II fractures, and avulsion fractures, which can all be managed functionally by supportive splinting and return to activities as tolerated by the patient.
Boutis et al. (2013) report a sensitivity of 98% and specificity of 54% with the sensitivity being consistent with previous validation studies, which gives it a strong clinical value in excluding a fracture.
The rule states that if a child presents with a low-risk injury on examination, which refers to tenderness and swelling that is isolated to the distal fibula and/or adjacent lateral ligaments distal to the tibial anterior joint line, taking an additional x-ray may not be necessary to exclude a clinically important ankle injury.
Other common tests to screen for ankle fractures are:
Malleolar Zone Algorithm for Fractures in Children