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Ankle Dislocation in Emergency Medicine

Background

Ankle dislocations without fracture occur when significant force applied to the joint results in loss of opposition of the articular surfaces. Because of the large amount of force required and the inherent stability of the tibiotalar joint, dislocation of the ankle joint is rarely seen without an associated fracture. Certain researchers argue this is due in part to the strength of the ankle joint ligaments and the relative weakness of the bones that make up the ankle.

A paucity in the medical literature exists illustrating critical examination of the injury, treatment protocol, and outcomes. In 1939, Wilson, Michele, and Jacobsen discussed ankle dislocations without fracture but were limited to 2 private patient case studies and only 14 cases that had been previously reported since 1913.
It was this study that attempted a literature review, evaluation of the mechanism, treatment, and results. Again, in 1991, further lack of ankle dislocation research prompted Moehring et al to compile one of the larger series of open ankle dislocation.
Recently, most literature demonstrates isolated cases studies of pediatric and adult tibiotalar/ankle dislocations.

Some controversy exists regarding the treatment of ankle dislocations. However, the outcomes appear to be satisfactory in cases treated with immediate reduction of the joint and relief of neurovascular stress as the primary goals of treatment.

Karampinas et al performed a retrospective evaluation of complete talar extrusion without associated fractures and immediate reimplantation and reported that it is important to attempt reimplantation of the talus because of good final outcomes. According to the authors, even in the case of a catastrophic complication, this technique ensures adequate bone stock for additional surgical procedures. The dislocated talus was reduced and held in place with 2 Steinmann pins placed from the inferior aspect of the calcaneus, through the talus, and into the inferior aspect of the tibia. An external fixator was used to stabilize the limb.

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