According to the Ottawa Ankle Rules, radiographs are required if a patient has pain in the malleolar zone and which of the following accompanying findings?

Explanation:
The Ottawa Ankle Rules are a highly sensitive clinical decision tool used to reduce unnecessary radiography. Ankle x-rays are indicated only if there is pain in the malleolar zone AND either: (1) bone tenderness along the distal 6 cm of the posterior edge of the tibia/medial malleolus, (2) bone tenderness along the distal 6 cm of the posterior edge of the fibula/lateral malleolus, OR (3) a total inability to bear weight both immediately and in the ED (4 steps). Ligamentous tenderness or swelling alone do not mandate an x-ray. Reference: Rockwood and Green's Fractures in Adults, 9th Edition.