Ankle Dislocation in Emergency Medicine Workup

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

Imaging Studies

  • Routine radiographic examination of the ankle includes the following views:
    • Anteroposterior
    • Lateral
    • Mortise or oblique views: These are taken with an internal rotation of 10-20 degrees. This places both the medial and lateral malleoli in the same horizontal plane, which provides optimum viewing of the tibial plafond and talar dome.
  • Obtain prereduction and postreduction films.
  • Computerized tomography (CT) may be indicated for evaluation of osseous structures, occult fractures, and alignment.
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Procedures

  • Reduction of the ankle joint (also see Joint Reduction, Ankle Dislocation)
    • In patients with obvious or complete neurovascular compromise, perform reduction prior to radiographic studies. Prompt reduction is important in reducing the risk of complications related to neurovascular compromise.
    • Reduction is accomplished with the knee in flexion to reduce tension on the Achilles tendon. With one hand on the heel and another on the dorsum of the foot, apply traction while maintaining countertraction at the knee. Entrapment of the tibialis posterior tendon (or of a fracture fragment within the joint space) may result in an irreducible dislocation.
    • Anesthesia includes Bier block, spinal block, conscious sedation with narcotics and/or benzodiazepines, or general anesthesia. Bier block is the preferred method because of its efficacy and risk profile, although time may not permit in cases of vascular compromise. One technique described is termed the hematoma block (injection of intra-articular local anesthetic into the ankle joint and associated fracture hematoma). Ross et al suggest this as an alternative to conscious sedation, avoiding the risks of seizure and/or respiratory arrest.[5]
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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].

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

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  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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