Ankle Dislocation in Emergency Medicine Clinical Presentation

  • Author: James E Keany, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 27, 2012
 

History

A detailed history regarding the mechanism of injury often helps predict the type of injuries to expect. Furthermore, an understanding of the injury mechanism aids treatment, since an opposite force is required in reduction of the joint. Because of the inherent stability of the ankle joint mortise and surrounding tendons and ligaments, dislocation is most usually caused by high-energy trauma that causes plantar flexion of the ankle combined with either inversion or eversion stress upon the foot.[1] Four types of dislocations are seen around the ankle joint: posterior, anterior, lateral, and superior:

  • Posterior
    • A posterior dislocation in the most common type of ankle dislocation. The talus moves in a posterior direction in relation to the distal tibia as force drives the foot backward. The wider anterior talus wedges back, resulting in forced widening of the joint.
    • This must be accompanied by either a disruption if the tibiofibular syndesmosis or a fracture if the lateral malleolus. This occurs most commonly when the ankle is plantar flexed.
  • Anterior
    • Anterior dislocations result from the foot being forced anteriorly at the ankle joint.
    • Typically, this occurs with the foot fixed and a posterior force applied to the tibia or with forced dorsiflexion.
  • Lateral
    • These dislocations result from forced inversion, eversion, or external or internal rotation of the ankle.
    • They are associated uniformly with fractures of either or both the malleoli or the distal fibula.
  • Superior
    • Diastasis occurs when a force drives the talus upward into the mortise. These dislocations usually are the result of a fall from a height.
    • In such cases, the patient should be evaluated carefully for concomitant spine injury and fracture of the calcaneus.
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Physical

  • Inspection of the ankle reveals significant edema with deformity ranging from trace to obvious. Tenting of the skin by the malleoli may be noted.
  • Palpation of the joint reveals tenderness along the joint line, corresponding to areas of capsular or ligamentous disruption.
  • In associated fractures, tenderness, deformity, or tenting proximal to the joint may be seen.
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Causes

Possible risk factors that may predispose a patient to dislocation include the following: joint hyperlaxity, internal malleolar hypoplasia, peroneal muscle weakness, and a history of prior ankle sprains.[1]

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Contributor Information and Disclosures
Author

James E Keany, MD, FACEP  Medical Director, TravelMDAssist; Staff Physician, Department of Emergency Services, Mission Hospital Regional Medical Center

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Dekker McKeever, DPM  Chief Podiatric Surgery Resident Physician, Trauma and Reconstruction Specialist, Mission Hospital Regional Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph J Sachter, MD, FACEP  Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center

Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Thangarajah T, Giotakis N, Matovu E. Bilateral ankle dislocation without malleolar fracture. J Foot Ankle Surg. Sep-Oct 2008;47(5):441-6. [Medline].

  2. Wilson M, Michele A, Jacobsen E. Ankle dislocations without fracture. JBJS. January 1939;21:198-204.

  3. Moehring HD, Tan RT, Marder RA, Lian G. Ankle dislocation. J Orthop Trauma. 1994;8(2):167-72. [Medline].

  4. Tarantino U, Cannata G, Gasbarra E, Bondi L, Celi M, Iundusi R. Open medial dislocation of the ankle without fracture. J Bone Joint Surg Br. Oct 2008;90(10):1382-4. [Medline].

  5. Ross A, Catanzariti AR, Mendicino RW. The hematoma block: a simple, effective technique for closed reduction of ankle fracture dislocations. J Foot Ankle Surg. Jul-Aug 2011;50(4):507-9. [Medline].

  6. Grotz MR, Alpantaki K, Kagda FH, Papacostidis C, Barron D, Giannoudis PV. Open tibiotalar dislocation without associated fracture in a 7-year-old girl. Am J Orthop (Belle Mead NJ). Jun 2008;37(6):E116-8. [Medline].

  7. Lübbeke A, Salvo D, Stern R, Hoffmeyer P, Holzer N, Assal M. Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study. Int Orthop. Jan 17 2012;[Medline].

  8. Agrawal AC, Raza H, Haq R. Closed posterior dislocation of the ankle without fracture. Indian J Orthop. Jul 2008;42(3):360-2. [Medline].

  9. Camarda L, Martorana U, D'Arienzo M. Posterior subtalar dislocation. Orthopedics. Jul 2009;32(7):530. [Medline].

  10. Daffner RH. Ankle trauma. Semin Roentgenol. Apr 1994;29(2):134-51. [Medline].

  11. Daffner RH. Ankle trauma. Radiol Clin North Am. Mar 1990;28(2):395-421. [Medline].

  12. Dean DB. Field management of displaced ankle fractures: techniques for successful reduction. Wilderness Environ Med. Spring 2009;20(1):57-60. [Medline].

  13. Distefano S, Divita G. A case of pure dislocation of the ankle joint. Ital J Orthop Traumatol. Mar 1988;14(1):133-7. [Medline].

  14. Finkemeier C, Engebretsen L, Gannon J. Tibial-talar dislocation without fracture: treatment principles and outcome. Knee Surg Sports Traumatol Arthrosc. 1995;3(1):47-9. [Medline].

  15. Graeme KA, Jackimczyk KC. The extremities and spine. Emerg Med Clin North Am. May 1997;15(2):365-79. [Medline].

  16. Greenbaum MA, Pupp GR. Ankle dislocation without fracture: an unusual case report. J Foot Surg. May-Jun 1992;31(3):238-40. [Medline].

  17. Griffiths HJ. Trauma to the ankle and foot. Crit Rev Diagn Imaging. 1986;26(1):45-105. [Medline].

  18. Krishnamurthy S, Schultz RJ. Pure posteromedial dislocation of the ankle joint. A case report. Clin Orthop Relat Res. Dec 1985;(201):68-70. [Medline].

  19. Merianos P, Papagiannakos K, Hatzis A, Tsafantakis E. Peritalar dislocation: a follow-up report of 21 cases. Injury. Nov 1988;19(6):439-42. [Medline].

  20. Mooney JF, Naylor PT, Poehling GG. Anterolateral ankle dislocation without fracture. South Med J. Feb 1991;84(2):244-7. [Medline].

  21. Schuberth JM. Diagnosis of ankle injuries: the essentials. J Foot Ankle Surg. Mar-Apr 1994;33(2):214. [Medline].

  22. Wehner J, Lorenz M. Lateral ankle dislocation without fracture. J Orthop Trauma. 1990;4(3):362-5. [Medline].

  23. Wilson AB, Toriello EA. Lateral rotatory dislocation of the ankle without fracture. J Orthop Trauma. 1991;5(1):93-5. [Medline].

  24. Wroble RR, Nepola JV, Malvitz TA. Ankle dislocation without fracture. Foot Ankle. Oct 1988;9(2):64-74. [Medline].

 
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