• Skip to main content
  • Skip to primary sidebar
  • Skip to footer
  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors
  • Newsletter/Updates
  • About Us
  • Contact Us

Bone and Spine

Orthopedic health, conditions and treatment

Ankle Dislocation Without Fracture

By Dr Arun Pal Singh

In this article
    • Relevant Anatomy of Ankle Joint and Pathophysiology
    • Type of Ankle Dislocations
      • Posterior
      • Anterior
      • Lateral
      • Superior
    • Presentation of Ankle Dislocation
    • Differential Diagnoses
    • Imaging
    • Treatment of Ankle Dislocation
    • References

Ankle dislocation often occurs with fractures of ankle bones especially malleolar fractures and talar fractures. A significant force is required to dislocate the ankle without the fracture. There is an inherent stability of the tibiotalar joint, therefore dislocation of the ankle joint is rarely seen without an associated fracture.

Usually, any dislocations that do occur are easily reduced by closed methods.

Ruptures of the deltoid ligament, the anterior tibiotalar ligament, and the anterior and posterior talofibular ligaments occur alone or in combination.

Dislocations of the ankle are seen more frequently in young males.

ankle dislocation without fracture
Dislocation of Ankle

Relevant Anatomy of Ankle Joint and Pathophysiology

The ankle joint is formed by distal part of the tibia including medial malleolus and the distal part of the fibula called lateral malleolus which articulates with talus bone. The bony arch formed by the tibial plafond and the two malleoli is referred to as the ankle mortise or talar mortise.

This articulates with the dome of the talus to form ankle joint.

The ankle joint is stabilized by many ligaments.

[Read more about ankle joint anatomy]

The ankle joint is designed for a balance of stability and flexibility.  Joint stability is provided by the close articulation of the talus with the tibia and fibula and mortise design.

The talus is trapezoidal in shape, with the greater width anteriorly and narrower posteriorly. As the joint moves into plantar flexion, the talus becomes narrower, resulting in a decrease in stability.

The position of plantar flexion is seen in conjunction with the supination of the foot. The foot being in a supinated position. Thus the ankle is vulnerable to inversion injury.

Associated fractures often occur with ankle dislocations. The type of ligamentous injury varies with the type of dislocation.

Neurovascular injury is the main concern. Vascular compromise may result in avascular necrosis of the talus, tissue necrosis or even gangrene.

The neural injury may result in a neural deficit, mainly sensory.

Possible risk factors that may predispose a patient to dislocation include the following: joint hyperlaxity, internal malleolar hypoplasia, peroneal muscle weakness, and a history of prior ankle sprains.

Type of Ankle Dislocations

Depending on the trauma and the forces involved four types of dislocations of the ankle are seen – posterior, anterior, lateral, and superior:

Posterior

The most common type of ankle dislocation. Often occurs when foot plantar flexed.

The talus is moved posteriorly in relation to the distal tibia with a backward force acting on the foot.

 The wider anterior talus results in forced widening of the joint and may cause a disruption of the tibiofibular syndesmosis or a fracture if the lateral malleolus.

Anterior

Anterior dislocations occur when the foot is anterior. It typically occurs with the foot fixed and a posterior force applied to the tibia. It may also occur in forced dorsiflexion.

Lateral

Lateral dislocations result from forced inversion, eversion, or external or internal rotation of the ankle. They are associated with fractures of either (or both) the malleoli or the distal fibula.

Superior

Superior dislocation is associated with diastasis of the ankle. It occurs when a force drives the talus upward into the mortise, usually seen as a result of a fall from a height.

Other injuries like spine and calcaneum are associated.

Presentation of Ankle Dislocation

There would always be a history of significant trauma, following which there is a deformity of the part and loss of the function [inability to bear weight or walk] and pain accompanied by swelling.

The examination would reveal significant edema. The deformity is usually visible except in gross swelling.

Tenting of the skin by the malleoli may be noted.

Palpation will reveal tenderness and distorted landmarks.

In associated fractures, tenderness, deformity, or tenting proximal to the joint may be seen.

Differential Diagnoses

  • Ankle Fracture
  • Subtalar Joint Subluxation

Imaging

Anteroposterior, lateral and mortise views/oblique view reveal the injury and if any associated fracture.

Computed tomography may be done to look for occult fractures, evaluation of alignment [after reduction]

Treatment of Ankle Dislocation

A prompt reduction is important in reducing the risk of complications related to neurovascular compromise.

The reduction may be attempted before x-rays especially in cases with neurovascular compromise.

Procedure of Reduction

  • Bring the knee in flexion to reduce tension on the Achilles tendon
  • Keep one hand on the heel and another on the dorsum of the foot
  • Apply traction while countertraction is given at the knee by the assistant
  • The direction of the force would vary with the type of dislocation
  • Gradually the reduce the ankle while reducing counteraction at the knee.

Tibialis posterior tendon entrapment or a bony fragment within the joint space may result in an irreducible dislocation warranting the open reduction.

The reduction may be done under sedation and as with all dislocations, there is no need to wait for anesthesia for attempting the reduction.

X-rays after reduction would confirm the reduction and alignment. In selected cases, an aid of CT may be taken for assessing the ankle after the reduction.

Patients should be immobilized in below knee splint after reduction of the ankle. Drugs for control of pain should be suitably given

References

  • Moehring HD, Tan RT, Marder RA, Lian G. Ankle dislocation. J Orthop Trauma. 1994. 8(2):167-72.
  • Greenbaum MA, Pupp GR. Ankle dislocation without fracture: an unusual case report. J Foot Surg. 1992 May-Jun. 31(3):238-40.
  • Wehner J, Lorenz M. Lateral ankle dislocation without fracture. J Orthop Trauma. 1990. 4(3):362-5

 

Spread the Knowledge
  • 1
    Share
  •  
    1
    Share
  • 1
  •  
  •  
  •  
  •  

Filed Under: Foot Ankle

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

Spinal Nerves

Spinal Nerves Structure, Types and Function

Spinal nerves are the nerves that originate in the spinal cord and form part of the peripheral nervous system. Spinal nerves are mixed types of nerves. A mixed nerve is one which transmits motor, sensory, and autonomic signals between the spinal cord and the body. In humans, there are 31 spinal nerves on each side […]

Lateral Dislocation of Elbow

Elbow Dislocation – Presentation & Treatment

Acute elbow dislocation in adults occurs at the ulnohumeral joint.  Elbow dislocation can be pure dislocation of associated with fractures of surrounding bones. Elbow is a very important part of upper limb function and plays a very important role in the positioning of the hand for grip and prehension. Various day to activities and recreational […]

Congenital Trigger Thumb, Notta nodule is marked

Pediatric or Congenital Trigger Thumb

Congenital trigger thumb or pediatric trigger thumb as it is called now is a condition that results in abnormal flexion at the interphalangeal joint. That is why it also called flexion contracture of the thumb. It is a separate entity than the adult trigger thumb. This occurs due to thickening and constriction of fibrous tendon […]

Cell saver for intraoperative blood salvage

Intraoperative Blood Salvage

Intraoperative blood salvage is a type of autotransfusion or transfusing patient’s own blood instead of allogenic blood retrieved from blood donors. It is also known as autologous blood transfusion or cell salvage. It is a medical procedure involving recovering blood lost during surgery and reinfusing it into the patient. In other words, the blood that […]

Man with genu valgum following knee injury

Genu Valgum Causes, Evaluation and Treatment

The term genu valgum or valgus knee is used to describe knock-knee deformity. Knock-knee deformity is commonly seen as-as a passing trait in otherwise healthy children but some individuals retain or develop this deformity due to hereditary, metabolic or other causes. As genu valgum is a normal physiologic process in children, therefore it is critical […]

myasthenia gravis

Myasthenia Gravis Causes, Symptoms and Treatment

The term myasthenia gravis has a Latin and Greek origin. It  literally means “grave muscle weakness.” Myasthenia Gravis is a chronic autoimmune neuromuscular disease that results in by varying degrees of weakness of the skeletal  muscles of the body. This weakness increases during periods of activity and improves after periods of rest. Certain muscles such […]

Carpal Bones Fractures

Carpal Bone Fractures

Carpal bone fractures is a collective term for fracture of the bones that make the carpus or wrist, also called carpal bones. Scaphoid fracture is most common of carpal bone fractures. Incidence of Carpal Bone Fractures Following is a rough approximate incidence of carpal bone fractures Scaphoid 68.2% Triquetrum 18.3% Trapezium 4.3% Lunate 3.9% Capitate […]

Browse Articles

Footer

Pages

  • About
    • Policies
    • Contact Us

Featured Article

Rotator Cuff Anatomy and Significance

The rotator cuff is a group of muscles and their tendons in the shoulder which connect the humerus scapula. The muscles in the rotator cuff include … [Read More...] about Rotator Cuff Anatomy and Significance

Search Articles

© Copyright: BoneAndSpine.com