Ankle Dislocations

Dr Low Tze Choong

Consultant Orthopaedic Surgeon
Kuala Lumpur Sports Medicine Center

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Ankle Dislocations
Occur when significant force applied to the joint results in
loss of opposition of the articular surfaces
Dislocation of the ankle joint is rarely seen without an
associated fracture
large amount of force required
inherent stability of the tibiotalar joint,
Due in part to the strength of the ankle joint ligaments and
the relative weakness of the bones that make up the ankle

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Pathophysiology
Ankle joint is designed for a balance of stability
and flexibility
Mortice and close articulation of the talus with
the tibia and fibula stability
Talus is trapezoidal
decrease in stability when in plantarflexion
Ankle remains vulnerable to inversion strain
and subsequent injury

Ankle Dislocations
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Mortality/Morbidity
Associated fractures are the rule rather than the
exception with ankle dislocations
Ligamentous disruption varies according to the type of
dislocation
Neurovascular injury is the principal concern
avascular compromise of the talus
permanent sensation or nerve damage
lower extremity tissue necrosis, and gangrene if
not promptly reduced
Tented skin may be subject to ischemic necrosis.

Ankle Dislocations
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Sex
More frequently in young males
related to their increased risk overall for traumatic
injury
Postmenopausal women are at higher risk for
associated fractures probably related to osteoporotic
changes
Age
Children and adolescents have the most ankle
dislocations

Ankle Dislocations
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History
Detailed history regarding the mechanism of injury
often helps predict the type of injuries to expect
Understanding the injury mechanism aids treatment
opposite force is required in reduction of the
joint
Dislocation is most usually caused by highenergy trauma that causes plantar flexion of the
ankle combined with either inversion or eversion
stress upon the foot

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Possible risk factors

Joint hyperlaxity
Internal malleolar hypoplasia
Peroneal muscle weakness
History of prior ankle sprains

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Four types of dislocations are seen

around the ankle joint:
Posterior
most common type
talus moves in a posterior direction in
relation to the distal tibia as force
drives the foot backward
Anterior
foot being forced anteriorly at the ankle
joint +/- forced dorsiflexion

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Four types of dislocations are seen around the

ankle joint:
Lateral
forced inversion, eversion, or external or internal
rotation of the ankle
associated uniformly with fractures
Superior
diastasis occurs when a force drives the talus
upward
fall from a height.

Ankle Dislocations
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Imaging Studies
Routine radiographic examination of the ankle:
o Anteroposterior
o Lateral
o Mortise or oblique views
Obtain pre-reduction and post-reduction films.
Computerized tomography (CT) may be indicated for
evaluation of osseous structures, occult fractures, and
alignment
MRI will be needed to assess soft tissue injuries

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Reduction
Patients with obvious or complete
neurovascular compromise, require
reduction prior to radiographic
studies
Prompt reduction is important in
reducing the risk of complications
related to neurovascular
compromise
Ankle splint while awaiting further
evaluation/tests

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Reduction
Knee in flexion to reduce tension on the
Achilles tendon
One hand on the heel and another on the
dorsum of the foot
apply traction while maintaining
countertraction at the knee
Entrapment of the tibialis posterior tendon (or
of a fracture fragment within the joint space)
may result in an irreducible dislocation
Requires open reduction
Anaesthesia: spinal block, conscious sedation
with Fentanyl/Propofol, or general anesthesia

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Further Inpatient Care

Dislocations of the ankle are, by definition,
unstable
disruption of the lateral or medial
ligaments or the tibio-fibular
syndesmosis
Admit for further evaluation and possible
intraoperative repair
internal or external fixation of any
associated fractures
repair of capsular or ligamentous tears

Ankle Dislocations

Complications
Nonunion or malunion
Synostosis
Entrapment of the tibialis posterior
tendon or of a fracture fragment
Cartilaginous injury
Osteochondral fractures of the talar
dome
Joint stiffness and decreased range of
motion
Arterial injury (anterior and posterior
tibial, peroneal)
Compartment syndrome (rare)

Ankle Dislocations

Prognosis
Dislocated ankles should not be
expected to return to pre-morbid
function
Amount of force and level of capsular
disruption required to dislocate the
inherently stable joint results in
significant injury with lasting effects
To a limited extent, prompt
intervention can reduce the risk of
complications

Ankle Dislocations

Thank You
Ankle Dislocations

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