Ankle Dislocation Management in the ED Treatment & Management

Updated: Jan 26, 2022
  • Author: James E Keany, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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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]