Prospective Validation and Head-to-Head Comparison of 3 Ankle Rules in a Pediatric Population

The Ottawa Ankle Rules identified all children with a clinically important fracture, whereas the Low-Risk Exam and the Malleolar Zone Algorithm showed lower sensitivities. The Low-Risk Exam showed the best specificity for clinically important fractures, decreasing the need for radiograph by 49%, but had missed 6 important fractures.