Ankle dislocation: Difference between revisions
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==Background== | ==Background== | ||
*Most ankle dislocations are | [[File:Slide3Bubu.jpg|thumb|Ankle anatomy: left ankle, anterior view.]] | ||
*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 | **Assoc with rupture of tibiofibular ligaments or lateral malleolus fracture | ||
==Clinical Features== | |||
*Ankle pain/trauma/deformity | |||
==Differential Diagnosis== | |||
*[[Subtalar dislocation]] | |||
{{Other ankle injuries DDX}} | |||
{{Distal leg fractures DDX}} | |||
{{Foot and toe fractures DDX}} | |||
==Evaluation== | |||
[[File:Ankledislocation.jpg|thumb|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== | ==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 | |||
===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== | |||
*May be discharged if: | |||
**Reduced | |||
**Normal neurovascular exam | |||
**No concern for [[compartment syndrome]] | |||
==See Also== | |||
*[[Ankle diagnoses]] | |||
*[[Ankle fracture]] | |||
*[[Foot dislocation]] | |||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:Orthopedics]] | |||
Latest revision as of 20:38, 13 May 2021
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 Fracture Types
- Tibial plateau fracture
- Tibial shaft fracture
- Pilon fracture
- Maisonneuve fracture
- Tibia fracture (peds)
- Ankle fracture
- Foot and toe fractures
Foot and Toe Fracture Types
Hindfoot
Midfoot
Forefoot
Evaluation
- 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
- May be discharged if:
- Reduced
- Normal neurovascular exam
- No concern for compartment syndrome
See Also
External Links
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.