Dislocations of the Ankle

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.