Prehospital Care

Prehospital personnel should immobilize the joint in keeping with standard procedure for any extremity injury.

If neurovascular compromise is identified in the field when examination reveals a cold, discolored, and pulseless or insensate foot, the joint should be realigned unless transport time is brief. This is accomplished by providing in-line traction with countertraction. Traction or splinting should be maintained en route to the hospital.

Intravenous opioids should be administered to keep the patient comfortable, 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 because delay may increase the risk of neurovascular compromise or damage to the articular cartilage. For 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.

Dislocations of the ankle are, by definition, unstable due to accompanying disruption of the lateral or medial ligaments or the tibiofibular syndesmosis. These injuries require an immediate orthopedic or podiatric consultation for surgical intervention that may involve internal or external fixation of any associated fractures and repair of capsular or ligamentous tears.^{[2, 19]}

Guidelines

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Media Gallery

Anatomy of the lateral ankle ligamentous complex and related structures.

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Author

James E Keany, MD, FACEP Associate Medical Director, Emergency Services, Mission Hospital Regional Medical Center, Children's Hospital of Orange County at Mission

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

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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 Association for Physician Leadership, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.