Patients without criteria for imaging by the Ottawa Ankle Rules are highly unlikely to have a clinically significant fracture and do not need plain radiographs. The rule is sensitive and not specific, it provides a clear guide of which patients not to x-ray if all criteria are met. The aim of this QIP is to check the adherence to Ottawa ankle rules for adult traumatic ankle x-rays in the emergency department of University Hospital Lewisham and reduce the number of unnecessary x-rays in the ED.