Ankle Dislocation and Reduction

imagesDislocated Ankle Joint


   imagesDemonstrated on plain radiographs


   imagesClinically dislocated with neurovascular compromise


CONTRAINDICATIONS



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


RISK/CONSENT ISSUES



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


   imagesAnalgesia/Sedation


   imagesReduce joint


   imagesCheck neurovascular status


   imagesImmobilize joint


   imagesPostprocedure radiographs


LANDMARKS



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


TECHNIQUE



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


imagesProcedure


   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


LATERAL DISLOCATION (FIGURE 67.1)



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


imagesTechnique


   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.


POSTERIOR DISLOCATION (FIGURE 67.1)



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



images


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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