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

Management

• Posterior dislocation
  • 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

See Also

• Ankle diagnoses
• Ankle fracture
• Foot dislocation