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How To Reduce an Ankle Dislocation
Step by Step Description of Ankle Dislocation Reduction
Neurovascular examination Do a pre-procedure neurovascular examination of the foot and ankle, including posterior tibial and dorsalis pedis pulses, capillary refill time (normally<2 seconds), and sensation of the foot's plantar surface (tibial nerve), dorsal surface (peroneal nerves), lateral surface (sural nerve), and medial surface (saphenous nerve). Analgesia Give How To Do Procedural Sedation and Analgesia (PSA). If using intra-articular anesthesia, first clean the anteromedial ankle area with antiseptic solution. Then, insert the needle as when doing arthrocentesis, perpendicularly to the skin just distal to the tibia, if possible anterior to the medial malleolus and lateral to the tibialis anterior tendon. Apply back pressure on the syringe plunger, and advance the needle posteriorly until synovial fluid is aspirated (if any blood is aspirated from the joint, aspirate all of the blood). Then inject 5 to 10 mL of anesthetic solution. Wait for analgesia to occur (up to 15 to 20 minutes) before proceeding. Reduce the ankle dislocation Place a pillow behind the knee of the affected leg, to flex the hip and the knee. Have one assistant grasp the calf with both hands, ready to pull cephalad (countertraction). Have a second assistant grasp the ankle with one hand (to stabilize lower leg). Grasp the foot, with one hand at the heel and the other hand at the forefoot. For a posterior dislocation: First free the talus from the distal tibia: Slightly plantarflex the foot and distract the heel axially (ie, pull it away) from the tibia, with the first assistant providing axial countertraction to the calf. Next, while maintaining axial distraction of the heel, and with the second assistant applying a counterforce to the anterior ankle, dorsiflex the foot, to reposition the talar dome anteriorly into the joint mortice. For an anterior dislocation: First dorsiflex the foot to distract the talus from the tibia. Apply axial traction and then push the foot directly backward while an assistant applies countertraction to the posterior part of the leg. For a lateral dislocation: Distract the heel axially from the tibia, then move the foot medially and dorsiflex it. For all dislocations: Successful reduction may be accompanied by a perceptible "clunk." 