I read Fiona Godlee's article with interest(1) and began wondering
just what made an investigation unnecessary especially as regards
suspected ankle fractures. The Ottawa ankle rules are inherently
subjective as bony tenderness can be interpreted in many different ways.
In reality the harm of a few extra radiographs when there is clinical
doubt is probably far less than missing the occassional ankle fracture. I
think common sense is far more valuable than a strict adherence to
guidelines, after all when a displaced ankle fracture is missed and early
osteoarthritis ensues, the potential cost to the health service is huge.
1. Fiona Godlee. How to avoid unnecessary interventions. BMJ 2009;
339: b3304
Rapid Response:
What is unnecessary?
I read Fiona Godlee's article with interest(1) and began wondering
just what made an investigation unnecessary especially as regards
suspected ankle fractures. The Ottawa ankle rules are inherently
subjective as bony tenderness can be interpreted in many different ways.
In reality the harm of a few extra radiographs when there is clinical
doubt is probably far less than missing the occassional ankle fracture. I
think common sense is far more valuable than a strict adherence to
guidelines, after all when a displaced ankle fracture is missed and early
osteoarthritis ensues, the potential cost to the health service is huge.
1. Fiona Godlee. How to avoid unnecessary interventions. BMJ 2009;
339: b3304
Competing interests:
None declared
Competing interests: No competing interests