The Bernese Ankle Rules: A Fast, Reliable Test after Low-Energy, Supination-Type Malleolar and Midfoot Trauma

BACKGROUND:Trauma of the midfoot and ankle joint are among the most commonly treated injuries in the emergency unit. The “Ottawa ankle rules” were introduced in 1992 to lower the amount of radiographs based on a standardized clinical examination. The weakness of the “rules” is the low specificity reported in several clinical studies. METHOD:We introduced a new indirect stress technique to examine the ankle and the midfoot after low-energy, supination-type trauma, avoiding direct palpation of the injured region. RESULTS:In 354 prospectively documented patients, the Bernese ankle test produced a sensitivity of 100% and a specificity of 91%. CONCLUSION:Compared with the original Ottawa ankle rules, the number of false-positive findings could be significantly reduced, resulting in a reduction of 84% in radiographs after low-energy, supination-type trauma ankle and midfoot trauma. Further investigations have to be performed to prove whether these findings are reproducible within other clinical settings, which could result in major cost savings for the health care system.