Prehospital personnel should immobilize the joint following standard procedure for any extremity injury.
If neurovascular compromise is identified in the field by examination, revealing a cold, discolored, and pulseless or insensate foot, the joint should be realigned unless transport time is brief. This is accomplished by in-line traction with countertraction. Traction or splinting should be maintained en route to the hospital (see Splinting, Ankle).
Intravenous opioids should be administered to make the patient comfortable and especially if traction is applied to reduce the dislocation en route. If intravenous opioids are unavailable, intravenous benzodiazepine medications can be used as an alternative.
Emergency Department Care
Early reduction is essential since delay may increase risk of neurovascular compromise or damage to articular cartilage. In patients with vascular compromise, perform reduction prior to radiologic examination.
Postreduction radiographs should confirm proper joint alignment. Appropriate pain management is the greatest contribution an emergency physician can make to the patient's care. Postreduction splinting is discussed below.
Dislocations of the ankle are, by definition, unstable due to accompanying disruption of the lateral or medial ligaments or the tibiofibular syndesmosis. These require an immediate orthopedic or podiatric consultation for surgical intervention that may involve the internal or external fixation of any associated fractures and repair of capsular or ligamentous tears. [12, 1]
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