Ankle dislocation: Difference between revisions
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===Background=== | ===Background=== | ||
*Most ankle dislocations are associated with a [[Ankle Fracture|fracture]] | *Most ankle dislocations are associated with a [[Ankle Fracture|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 | *Posterior dislocation is most common | ||
**Assoc with rupture of tibiofibular ligaments or lateral malleolus fracture | **Assoc with rupture of tibiofibular ligaments or lateral malleolus fracture | ||
===Management=== | ===Management=== | ||
* | *Posterior dislocation <ref name="Procedures for orthopedic emergencies">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.</ref> | ||
** | **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 | |||
*Check pulses after any attempts. If not palpable, consult ortho emergently | |||
*Post reduction | |||
**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 | |||
*Pearls | |||
**Flex hip and knee to 90 degrees to relax gastroc/soleus | |||
==Sub-Talar Dislocation== | ==Sub-Talar Dislocation== | ||
Revision as of 17:41, 16 April 2017
Tibiotalar 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
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
- Check pulses after any attempts. If not palpable, consult ortho emergently
- Post reduction
- 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
- Pearls
- Flex hip and knee to 90 degrees to relax gastroc/soleus
Sub-Talar Dislocation
Background
- Orthopedic emergency
Evaluation
- Plain radiographs usually sufficient
Management
- Immediate ortho consultation and reduction
See Also
References
- ↑ 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.