Ankle Dislocation and Reduction

imagesDislocated Ankle Joint

   imagesDemonstrated on plain radiographs

   imagesClinically dislocated with neurovascular compromise


imagesOpen dislocations without neurovascular compromise may be better managed in the operating room for cleaning before reduction

imagesAfter one or two unsuccessful attempts at reduction, orthopedic consultation should be considered


imagesNeurovascular damage may result from reduction attempt

imagesClosed reduction may be unsuccessful and operative repair may be required

imagesRisks of intravenous (IV) analgesia/sedation

imagesRisks of regional anesthesia

imagesGeneral Basic Steps

   imagesPatient preparation

   imagesObtain radiographs


   imagesReduce joint

   imagesCheck neurovascular status

   imagesImmobilize joint

   imagesPostprocedure radiographs


imagesThe ankle joint is a modified saddle joint that comprises the distal fibula, tibia, and the talus bone of the foot

imagesIs a stable joint with strong ligamentous support

imagesDislocations are a result of significant forces applied to the ankle and are often associated with fractures; isolated dislocations are uncommon


imagesPreprocedure Examination

   imagesSearch for other injuries, especially if high-energy mechanism

   imagesCheck neurovascular status of the foot

   imagesGet prereduction radiographs of dislocation (anteroposterior [AP], lateral, mortise views)

      imagesIf there is neurovascular compromise or tenting of the skin, perform immediate reduction before obtaining radiograph

   imagesTry to ascertain the mechanism of injury

imagesAnalgesia and Sedation

   imagesProcedural sedation

   imagesRegional analgesia

      imagesBier block

      imagesHematoma block


   imagesTechnique depends on type of dislocation but, in general, involves downward traction on heel while a force opposite to the direction of the dislocation is applied

   imagesFlexion of the hip and knee to 90 degrees may aid reduction by relaxing the gastrocnemius–soleus complex

      imagesIf no assistant is available this can be accomplished by hanging the patient’s knee over the end of the bed


imagesMost common ankle dislocation seen in the emergency department (ED)

imagesUsually result of forced inversion of the foot

imagesAssociated with malleolar or distal fibula fractures

imagesMay be associated with rupture of the deltoid ligament

imagesPresents with foot laterally displaced with the skin very taut over the medial aspect of the ankle joint


   imagesPlace one hand on the heel and the other on the dorsum of the foot

   imagesApply longitudinal traction to the foot

   imagesWhile assistant applies countertraction to the leg, gently manipulate the foot medially. Successful reduction usually produces a palpable thud.


imagesUsually result of forced plantar flexion or a strong forward force applied to the posterior tibia

imagesMost are associated with a fracture of one or more malleoli

imagesPresents with the ankle held in plantar flexion with foot shortened in appearance and resistant to dorsiflexion


FIGURE 67.1 Four types of ankle dislocations. A: Posterior. B: Anterior. C: Superior. D: Lateral. (From Simon RR, Brenner BE. Emergency Procedures and Techniques. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:285, with permission.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Ankle Dislocation and Reduction
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