Clinical features: The first case was an 8-year-old girl who was struck on the arm while playing. She experienced pain but refused to let anyone examine her arm. The second case was a 24-year-old male who fell 5 days earlier and landed on his right hand. The application of the adapted Ottawa rules suggested the potential for fracture, which was subsequently confirmed by radiographs.
Intervention and outcome: Radiographs confirmed the fracture and both patients were referred for orthopedic consultation and treatment.
Conclusion: These two cases, where the clinical decision making for a wrist injury was guided by an adaptation of the Ottawa ankle rules, highlight the lack of guidelines for upper extremity x-rays following injury and suggest that the Ottawa rules could form the basis for such guidelines. Further studies are required to demonstrate their reliability and validity for everyday clinical use.
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