The Importance of Reproducing the Injury

Ankle dislocations are usually the result of high-energy trauma that cause plantar flexion of the ankle combined with an inversion or eversion stress. These dislocations are typically described according to the direction of displacement of the talus and foot in relation to the tibia. Consequently, dislocation may be upward, posterior, medial, lateral, posteromedial, or anterior. Posterior dislocation of the talus is the most common form of ankle dislocation. Associated fractures are the rule rather than exception, and ligamentous disruption varies according to the type of dislocation. One of the most dramatic joint dislocations is the open, dislocated ankle. A principal concern, in addition to timely reduction, is the possibility of a neurovascular injury. Radiographs should not delay reduction in cases where vascular compromise or skin tenting is present. After reduction, reassessment of the neurovascular status, splinting, ankle elevation, and post-reduction radiography are accomplished. The reduction procedure is accomplished with the patient lying supine. After procedural sedation and analgesia, the knee is flexed to 90 degrees. Distraction of the foot, followed by a gentle force reversing direction of the dislocation is sometimes all that is needed, though a more forceful maneuver may be needed. Many open ankle fractures and dislocations will not be reduced unless the injury mechanism is first recreated. This important tenet of orthopedic surgery is freque...
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