Ankle dislocation - Revision history

Rossdonaldson1: /* Background */

2021-05-13T20:38:05Z

Background

← Revisión anterior		Revisión del 20:38 13 may 2021
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	==Background==		==Background==
	[[File:Slide3Bubu.jpg\|thumb\|Ankle anatomy.]]		[[File:Slide3Bubu.jpg\|thumb\|Ankle anatomy: left ankle, anterior view.]]
	*Most ankle dislocations are associated with a [[Ankle Fracture\|fracture]]		*Most ankle dislocations are associated with a [[Ankle Fracture\|fracture]]
	*Must rule-out neurovascular compromise and conversion to [[open fracture]]		*Must rule-out neurovascular compromise and conversion to [[open fracture]]

Rossdonaldson1: /* Background */

2021-05-13T20:36:42Z

Background

← Revisión anterior		Revisión del 20:36 13 may 2021
Línea 1:		Línea 1:
	==Background==		==Background==
			[[File:Slide3Bubu.jpg\|thumb\|Ankle anatomy.]]
	*Most ankle dislocations are associated with a [[Ankle Fracture\|fracture]]		*Most ankle dislocations are associated with a [[Ankle Fracture\|fracture]]
	*Must rule-out neurovascular compromise and conversion to [[open fracture]]		*Must rule-out neurovascular compromise and conversion to [[open fracture]]

Rossdonaldson1: /* Disposition */

2021-05-13T20:25:18Z

Disposition

← Revisión anterior		Revisión del 20:25 13 may 2021
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	==Disposition==		==Disposition==
			*May be discharged if:
			**Reduced
			**Normal neurovascular exam
			**No concern for [[compartment syndrome]]

	==See Also==		==See Also==

Rossdonaldson1: /* Evaluation */

2017-04-28T17:50:28Z

Evaluation

← Revisión anterior		Revisión del 17:50 28 abr 2017
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	==Evaluation==		==Evaluation==
			[[File:Ankledislocation.jpg\|thumb\|Rraumatic dislocation of the ankle (tibiotarsal) with distal fibular fracture. Open arrow marks the tibia and the closed arrow marks the talus.]]
	*Ankle x-ray		*Ankle x-ray

Rossdonaldson1: /* Management */

2017-04-27T13:15:26Z

Management

← Revisión anterior		Revisión del 13:15 27 abr 2017
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	==Management==		==Management==
	~~''Flex hip and knee to 90 degrees to relax gastroc/soleus''~~
	===Posterior dislocation <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>===		===Posterior dislocation <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>===
	*Assistant places hands under knee and distal thigh to pull counter traction		*Assistant places hands under knee and distal thigh to pull counter traction
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	**Document pulse/motor/sensory exam before and after any attempts at reduction		**Document pulse/motor/sensory exam before and after any attempts at reduction
	*Splint in posterior as well as sugar tong splint with foot in 90 degree flexion		*Splint in posterior as well as sugar tong splint with foot in 90 degree flexion
			**Flex hip and knee to 90 degrees to relax gastroc/soleus

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2017-04-27T13:14:45Z

Management

← Revisión anterior		Revisión del 13:14 27 abr 2017
Línea 22:		Línea 22:

	==Management==		==Management==
			''Flex hip and knee to 90 degrees to relax gastroc/soleus''
	===Posterior dislocation <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>===		===Posterior dislocation <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>===
	*Assistant places hands under knee and distal thigh to pull counter traction		*Assistant places hands under knee and distal thigh to pull counter traction
Línea 39:		Línea 40:
	**Document pulse/motor/sensory exam before and after any attempts at reduction		**Document pulse/motor/sensory exam before and after any attempts at reduction
	*Splint in posterior as well as sugar tong splint with foot in 90 degree flexion		*Splint in posterior as well as sugar tong splint with foot in 90 degree flexion
	*Pearls
	**Flex hip and knee to 90 degrees to relax gastroc/soleus

	==Disposition==		==Disposition==

Rossdonaldson1: /* Clinical Features */

2017-04-27T13:14:15Z

Clinical Features

← Revisión anterior		Revisión del 13:14 27 abr 2017
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	==Clinical Features==		==Clinical Features==
			*Ankle pain/trauma/deformity

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Evaluation */

2017-04-27T13:13:46Z

Evaluation

← Revisión anterior		Revisión del 13:13 27 abr 2017
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	==Evaluation==		==Evaluation==
			*Ankle x-ray

	==Management==		==Management==

Rossdonaldson1 at 13:13, 27 April 2017

2017-04-27T13:13:28Z

← Revisión anterior		Revisión del 13:13 27 abr 2017
Línea 1:		Línea 1:
	==Background==		==Background==
	*Most ankle dislocations are associated with a [[Ankle Fracture\|fracture]]		*Most ankle dislocations are associated with a [[Ankle Fracture\|fracture]]
	*Must rule-out neurovascular compromise and conversion to open fracture		*Must rule-out neurovascular compromise and conversion to [[open fracture]]
	**Reduce immediately if vascular compromise or skin tenting is present		**Reduce immediately if vascular compromise or skin tenting is present
	*Posterior dislocation is most common		*Posterior dislocation is most common
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	==Management==		==Management==
	*Posterior dislocation <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>		===Posterior dislocation <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>===
	**Assistant places hands under knee and distal thigh to pull counter traction		*Assistant places hands under knee and distal thigh to pull counter traction
	**Hold dorsum of mid foot with one hand and heel with other hand. Pull longidtudinally then anteriorly		*Hold dorsum of mid foot with one hand and heel with other hand. Pull longidtudinally then anteriorly
	**If no assistant, have patient hang leg over edge of stretcher		*If no assistant, have patient hang leg over edge of stretcher
	*Anterior dislocation
	**As above, but dorsiflex foot first to disengage talus		===Anterior dislocation===
	**Then axial traction while assistant is holding traction on tibia		*As above, but dorsiflex foot first to disengage talus
	**Finally push foot posteriorly while assistant adds pulls anteriorly		*Then axial traction while assistant is holding traction on tibia
	*Lateral dislocation		*Finally push foot posteriorly while assistant adds pulls anteriorly
	**Plantar flex foot then apply traction with assistant holding counter traction
			===Lateral dislocation===
			*Plantar flex foot then apply traction with assistant holding counter traction

			===Post reduction (all)===
	*Check pulses after any attempts. If not palpable, consult ortho emergently		*Check pulses after any attempts. If not palpable, consult ortho emergently
	*Post reduction
	**Document pulse/motor/sensory exam before and after any attempts at reduction		**Document pulse/motor/sensory exam before and after any attempts at reduction
	**Splint in posterior as well as sugar tong splint with foot in 90 degree flexion		*Splint in posterior as well as sugar tong splint with foot in 90 degree flexion
	*Pearls		*Pearls
	**Flex hip and knee to 90 degrees to relax gastroc/soleus		**Flex hip and knee to 90 degrees to relax gastroc/soleus

Rossdonaldson1: /* Differential Diagnosis */

2017-04-27T13:10:34Z

Differential Diagnosis

← Revisión anterior		Revisión del 13:10 27 abr 2017
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	==Differential Diagnosis==		==Differential Diagnosis==
			*[[Subtalar dislocation]]

			{{Other ankle injuries DDX}}

			{{Distal leg fractures DDX}}

			{{Foot and toe fractures DDX}}

	==Evaluation==		==Evaluation==