Presentation
Information presented as part of this activity is intended solely as continuing medical education and is not intended to promote off-label use of any pharmaceutical product. [ebmedicine.net]
POSTERIOR DISLOCATION ( FIGURE 67.1 ) Usually result of forced plantar flexion or a strong forward force applied to the posterior tibia Most are associated with a fracture of one or more malleoli Presents with the ankle held in plantar flexion with foot [aneskey.com]
In majority of reported case it presents as an open injury making the closed injury more rare presentation. The stability of the ankle joint depends on medial and lateral ligaments. [ncbi.nlm.nih.gov]
A case report is presented below to help accurately diagnose and treat the Bosworth ankle fracture-dislocation. [www2.aoao.org]
Despite initial presentation that revealed lack of posterior tibial pulse, the post‐surgical course was uneventful, with full functional recovery and joint mobility. [onlinelibrary.wiley.com]
Entire Body System
- Fever
Let your provider know if you have any numbness or swelling in your leg, or a high fever. Call 911 if you have any sudden, severe symptoms, such as sudden shortness of breath. [urmc.rochester.edu]
During his hospital stay, he had a low grade fever and mild leukocytosis during the first 24 hours, but was afebrible with a normal white count thereafter. Wound cultures were negative over three days. [faoj.org]
- Rigor
Faculty Disclosure: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. [ebmedicine.net]
- High Fever
Let your provider know if you have any numbness or swelling in your leg, or a high fever. Call 911 if you have any sudden, severe symptoms, such as sudden shortness of breath. [urmc.rochester.edu]
Cardiovascular
- Thrombosis
You have signs of a blood clot in your leg (called a deep vein thrombosis), such as: Pain in your calf, back of the knee, thigh, or groin. Redness or swelling in your leg. [myhealth.alberta.ca]
Skin
- Blister
Treatment of fracture blisters: a prospective study of 53 cases. Orthop Trauma. 1995;9:171-6. Saied A, Ziayie A. Neglected ankle dislocation. J Foot Ankle Surg. 2007;46:307-9. [ijoro.org]
[…] under the cast or splint The toes on the foot of your injured leg are cold, blue, numb, or tingly The injury doesn’t seem to be healing You can't move your toes on the foot of your injured leg The skin is discolored (looks blue, purple, or gray), has blisters [fairview.org]
[…] under the cast or splint The toes on the foot of your injured leg are cold, blue, numb, or tingly The injury doesn’t seem to be healing You can’t move your toes on the foot of your injured leg The skin is discolored (looks blue, purple, or gray), has blisters [doctorstelemedicine.com]
There was moderate left ankle swelling with associated medial ecchymosis and a 2 cm medial fracture blister. Pulses were weakly palpable, but the foot was warm and the capillary refill was brisk. Gross motor was intact. [www2.aoao.org]
- Ulcer
Talk with your provider beforeusing these medicines if you have chronic liver or kidney disease, or have ever had a stomach ulcer or GI (gastrointestinal) bleeding. Follow-up care Follow up with your healthcare provider within 1 week, or as advised. [fairview.org]
Musculoskeletal
- Arthritis
As well, if the bones do not perfectly align after injury, the risk of arthritis in the future increases. Arthritis of the joint may cause pain and stiffness. [medicinenet.com]
The incidence of post-traumatic arthritis in experimental and control group were 0 and 24.24% ( P = 0.0006), respectively. [bmcsurg.biomedcentral.com]
Long-term complications of dislocations include: Arthritis. This is unfortunately common in the decades following an ankle dislocation. Ongoing weakness in the ankle ligaments and a tendency to sprain the ankle. [orthoanswer.org]
If a malunion does occur or if your ankle becomes unstable after it heals, this can eventually lead to arthritis in your ankle. [orthoinfo.aaos.org]
These can include an infection or arthritis in the ankle. Next steps Tips to help you get the most from a visit to your healthcare provider: Know the reason for your visit and what you want to happen. [urmc.rochester.edu]
- Short Legs
After reduction his ankle was immobilized for 3 weeks in a short leg slab followed by wearing walking boots with progressive weight bearing until full weight bearing was reached. [omicsonline.org]
leg cast, non-weight bearing for 3-6 weeks (may consider short leg posterior/AO splint in ED after reduction for presumed swelling with close ortho follow up to transition to cast) ( DeLee JC 1982 ) Complications Post-Traumatic Arthritis Small number [emdocs.net]
Optimum treatment appears to be immobilization in a short leg cast for 6 weeks with no weightbearing for the first 3 weeks. Long-term follow-up revealed the following. [ncbi.nlm.nih.gov]
The fracture may be treated with a short leg cast or a removable brace. Usually, you need to avoid putting weight on your leg for approximately 6 weeks. [orthoinfo.aaos.org]
- Ankle Pain
SLIDESHOW Pain-Relief Tips for Bumps, Bruises, Sprains, and Strains in Pictures See Slideshow Symptom of Dislocated Ankle Ankle Pain Pain in the ankle can result from inflammation or injury to any of the structures in this region, including the bones, [medicinenet.com]
Reduce immediately if vascular compromise or skin tenting is present Posterior dislocation is most common Assoc with rupture of tibiofibular ligaments or lateral malleolus fracture Clinical Features Ankle pain/trauma/deformity Differential Diagnosis [wikem.org]
Listen to your body If you experience foot and ankle pain during a sport, stop the activity or modify the activity until the pain subsides. [ucsfhealth.org]
With your ankle injury, you may have symptoms such as: Immediate, severe pain Swelling and bruising Soreness to the touch Inability to put weight on your foot Trouble moving your ankle A deformed look to your ankle A bone that pokes through your skin [urmc.rochester.edu]
Five patients complained of ankle pain after excessive physical activities, but the pain was relieved after rest. [bmcsurg.biomedcentral.com]
- Joint Stiffness
According to several authors, Instability is uncommon as well as joint stiffness [ 5, 6 ]. Elisé et al. [ 7 ] reported in their series of 16 cases an incidence of 25% of degenerative changes in the ankle joint. [ncbi.nlm.nih.gov]
Complications of the tibiotalar dislocation include degenerative changes (25%), and, in very rare occasions, avascular necrosis, joint stiffness, and instability may also occur 9, 12. [onlinelibrary.wiley.com]
In addition to neurovascular complications, a 5–10° loss in the range of dorsiflexion, joint stiffness, tibiotalar joint instability, degenerative arthritis, and capsular calcification can be seen as late complications. 2, 3, 10– 12 Elise et al 10 reported [bjsm.bmj.com]
A slight loss of dorsiflexion, joint stiffness, joint instability, degenerative arthritis, and capsular calcification can be seen as late complications. [omicsonline.org]
[…] instability Deformity of the joint area Reduced muscle strength Bruising or redness of joint area Difficulty moving joint Stiffness Causes [ edit ] Joint dislocations are caused by trauma to the joint or when an individual falls on a specific joint. [en.wikipedia.org]
- Ankle Arthritis
You might have complications from your ankle dislocation, such as: Stiffness in your joint (physical therapy may help) Ankle arthritis causing lasting (chronic) ankle pain Infection, which may need treatment with antibiotics or follow-up surgery A broken [urmc.rochester.edu]
If the bones of your ankle are not aligned properly or the blood supply to your ankle is compromised, you are at risk of developing arthritis. This present as pain and stiffness in your ankle. [25doctors.com]
One year after the initial injury, the radiological findings were negative for any signs of osteonecrosis or early signs of ankle arthritis ( Fig. 3 ). [tandfonline.com]
Treatment
While these treatment methods have been documented through a written format, a formal treatment algorithm has yet to be developed. [livingstonpodiatry.com]
Preferred Name Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal fixation Synonyms Open reduction of dislocation of ankle ID http://purl.bioontology.org/ontology/CPT/27846 altLabel Open reduction [bioportal.bioontology.org]
Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Posteromedial dislocation of the ankle without fracture. [wheelessonline.com]
Bohler L. the treatment of Fractures, English ed. 4, William Wood Publishers, Baltimore; 1936: 453. Giordana CP, Koval KJ. Treatment of fracture blisters: a prospective study of 53 cases. Orthop Trauma. 1995;9:171-6. Saied A, Ziayie A. [ijoro.org]
Patients receive treatment at Yale-New Haven Hospital--a nationally recognized Level I Trauma Center. [yalemedicine.org]
Prognosis
Prognosis of an Dislocated Ankle The prognosis of an ankle dislocation depends on the amount of damage to the ankle. If there is any joint cartilage damage, it predisposes the ankle to development of arthritis. [footankleinstitute.com]
[…] capsular structures is often severe, and the risk of infection secondary to open injury is often significant; however, prompt reduction and, when warranted, operative debridement and repair usually lead to excellent functional recovery and long-term prognosis [emedicine.medscape.com]
To date, there has been no precedent for accurate descriptions of the mechanisms, optimum treatment, and long-term prognosis of this injury. Our goal was to evaluate these variables by a retrospective review of cases from our institution. [ncbi.nlm.nih.gov]
Prognosis Most people recover full function following a course of conservative care of physical therapy to strengthen and stabilize the ankle following the immobilization period. [twinboro.com]
However, early reduction, young age, and the absence of vascular and neuronal injury were associated with a better overall prognosis in our case. [onlinelibrary.wiley.com]
Etiology
A=initial encounter, D=subsequent encounter, S=sequela Ankle Dislocation ICD-9 837.0(closed), 837.1(open) Ankle Dislocation Etiology / Epidemiology / Natural History Ankle Dislocation Anatomy Ankle Dislocation Clinical Evaluation Ankle Dislocation Xray [eorif.com]
Background & Etiology (Cause) The ankle is made of two joints. These joints need to be strong because they support the weight of the entire body. The ankle is one of the most versatile joint complexes in the body. [twinboro.com]
Epidemiology
A=initial encounter, D=subsequent encounter, S=sequela Ankle Dislocation ICD-9 837.0(closed), 837.1(open) Ankle Dislocation Etiology / Epidemiology / Natural History Ankle Dislocation Anatomy Ankle Dislocation Clinical Evaluation Ankle Dislocation Xray [eorif.com]
The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014 Jan;44(1):123-40. [danielebarnabei.it]
"The Epidemiology of Finger Dislocations Presenting for Emergency Care Within the United States". HAND. 11 (2): 192–6. doi : 10.1177/1558944715627232. PMC 4920528. [en.wikipedia.org]
Epidemiology Associated fractures are the rule rather than the exception with ankle dislocations. Ligamentous disruption varies according to the type of dislocation. (See Ankle Injury, Soft Tissue .) [emedicine.medscape.com]
The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med 1977 ; 5 : 241 –2. ↵ Elise S, Maynou C, Mestdagh H, et al. Les luxations tibio-astragaliennes pures a propos de 16 observations. [bjsm.bmj.com]
Pathophysiology
Dislocation of Ankle Relevant Anatomy of Ankle Joint and Pathophysiology The ankle joint is formed by distal part of the tibia including medial malleolus and the distal part of the fibula called lateral malleolus which articulates with talus bone. [boneandspine.com]
Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability. J Athl Train. 2002 Dec;37(4):364-375. Jeffrey D Tiemstra. Update on acute ankle sprains. Am Fam Physician. 2012 Jun 15;85(12):1170-6. [danielebarnabei.it]
An external fixator was used to stabilize the limb. [5] Pathophysiology The ankle joint is designed for a balance of stability and flexibility, particularly the former. [emedicine.medscape.com]
Prevention
Is it possible to prevent a dislocated ankle? A dislocated ankle is an accidental injury and most often cannot be prevented. [medicinenet.com]
Prevention of Lateral Ankle Sprains. J Athl Train. 2019 Jun;54(6):650-661. [danielebarnabei.it]
Within the first few months of returning to training, stretching exercises may be performed to keep the area stable and strong and can also help prevent the injury reoccurring. [firstaid4sport.co.uk]
Crutches help you keep your weight off your ankle, and help prevent more ankle damage. Physical therapy: A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain. [drugs.com]
Prevent recurrent injuries Athletes who have experienced ankle injuries previously may benefit from using a brace or tape to prevent recurrent ankle injuries. [ucsfhealth.org]