Ankle dislocation

Background
  • Most ankle dislocations are associated with a fracture
  • Must rule-out neurovascular compromise and conversion to open fracture
    • Reduce immediately if vascular compromise or skin tenting is present
  • Posterior dislocation is most common
    • Assoc with rupture of tibiofibular ligaments or lateral malleolus fracture

Clinical Features
  • Ankle pain/trauma/deformity

Differential Diagnosis

Other Ankle Injuries

Distal Leg Fractures

Foot and Toe Fractures

Hindfoot

Midfoot

Forefoot

Evaluation
Rraumatic dislocation of the ankle (tibiotarsal) with distal fibular fracture. Open arrow marks the tibia and the closed arrow marks the talus.
  • Ankle x-ray

Management

Posterior dislocation [1]
  • Assistant places hands under knee and distal thigh to pull counter traction
  • Hold dorsum of mid foot with one hand and heel with other hand. Pull longidtudinally then anteriorly
  • If no assistant, have patient hang leg over edge of stretcher

Anterior dislocation
  • As above, but dorsiflex foot first to disengage talus
  • Then axial traction while assistant is holding traction on tibia
  • Finally push foot posteriorly while assistant adds pulls anteriorly

Lateral dislocation
  • Plantar flex foot then apply traction with assistant holding counter traction

Post reduction (all)
  • Check pulses after any attempts. If not palpable, consult ortho emergently
    • Document pulse/motor/sensory exam before and after any attempts at reduction
  • Splint in posterior as well as sugar tong splint with foot in 90 degree flexion
    • Flex hip and knee to 90 degrees to relax gastroc/soleus

Disposition

See Also

References
  1. Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.
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