Dislocations of the Ankle
Ankle dislocations are the result of substantial forces imparted to the joint, which disrupt the integrity of the joint structures and often result in associated fractures. As with any joint dislocation, neurovascular damage is of great concern. This is especially true with regards to preservation of the talus, which lacks a consistent blood supply. In general, four types of joint dislocations are seen in the ankle and include posterior, anterior, lateral, and superior. Posterior dislocations are the most common type found and are the result of a force that moves the talus posterior to the tibia. As a result of the increased cross-sectional area of the anterior talus, posterior displacement of this bone can potentially interrupt tibiofibular syndesmosis and consequently lead to fractures. Anterior dislocations are usually the product of an anteriorly directed force on the posterior aspect of the ankle while the foot is suspended in the open kinetic chain. This dislocation may also result from a significant posteriorly directed force imparted to the anterior face of the tibia, as the foot remains fixed in the closed kinetic chain. Lateral dislocations are associated with hyperinversion, hypereversion, or excessive rotational excursion of the ankle joint and are often associated with fractures of the ankle and distal fibula. Dislocations of the upper joint are often caused by displacement of the talus within the mortise of the ankle and usually occur after violent falls from a considerable height.
Complications of Hip Joint Dislocations
■ Osteoarthritis
■ Femoral neurovascular compromise specific to
anterior dislocation
■ Chronic hip joint instability
■ Avascular necrosis of the femoral head
■ Sciatic nerve pathology subsequent to posterior
dislocation
Physical
examination of the ankle joint following dislocation often reveals obvious anatomical
deformity, significant effusion, and considerable pain. These specific
conditions warrant immediate activation of EMS because of
complexities
involved for reducing the respective joint dislocations. While awaiting definitive
care the athletic trainer must monitor the athlete’s neurovascular status
frequently. Furthermore, the ankle must be appropriately splinted in the position
found. The high potential for associated fractures precludes reduction attempts
on the field. Early reduction at a hospital diminishes the likelihood for
associated AVN or neurovascular compromise. The athletic trainer assumes the
responsibilities of medical
emergency
management, triage, and judgment concerning return to play during sporting
events. As such, athletic trainers must be properly prepared to recognize
traumatic life- and limb-threatening situations. As allied health
professionals, athletic trainers should be competent in providing preliminary
emergency medical care of such conditions and regulating appropriate referral
when necessary. All athletic trainers should be cognizant of clinical standards
and field protocols pertaining to the correct management of orthopedic trauma.
This helps ensure that optimal successful outcomes
are
highly likely when rendering emergency medical care of orthopedic sports
injuries.
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