I could probably recite the ankle rules in my sleep, but found the following clarification of details helpful:
- ‘Malleolus’ includes the lower 6 cm (posterior edge or tip)
- ‘Weight-bearing’ means ability to walk four steps both immediately and in the A&E department.
- The navicular is slightly further posterior than I thought – the bone just in front of the talus, with one other tarsal (probably the medial cuneiform, but don’t quote me on that) between that and the first metatarsal.
Also, beware of complete ligamentous disruption even in the non-fractured ankle/foot – this is tested for with the drawer test (looking for appreciable movement of the forefoot relative to the ankle or severe pain when the ligaments are stressed).
Edited to add: Knee rules:
- Age >55
- Fibular head tenderness
- Discomfort confined to the patella on palpation
- Inability to flex to 90%
- Inability to WB for at least 4 steps
(BMJ 2009; 339: 400 – 1, 15th August; BMJ 2012; 345: 46 – 8, 21st July)