Ankle dislocation is a pathological condition in which there is a complete displacement of the articular surfaces of the bones forming the ankle joint. Complete ankle dislocation is rare and is usually observed in combination with a fracture of the ankles. In everyday life, sprains are often called sprains, tears and ruptures of the ligaments of the ankle joint, in which there may be a subluxation – a partial displacement of the articular surfaces. Dislocation and subluxation are accompanied by pain, swelling, impaired movement and support. The diagnosis is made taking into account the examination and radiography data. Sometimes CT or MRI is additionally prescribed. Treatment of subluxations is conservative. With a complete dislocation, an attempt is made to close the reduction, if it is impossible to compare the articular surfaces and bone fragments, an operation is performed.
S93.0 Ankle dislocation
Ankle dislocation is the displacement of the articular surfaces of the tibia, talus and fibula relative to each other. Complete ankle dislocation are rare, are a severe injury, combined with intra-articular and periarticular fractures.
Incomplete dislocations (subluxations) of the ankle joint can occur when ligaments are damaged (both isolated and with simultaneous fractures of the ankles). Usually, the cause of the injury is the twisting of the leg. Less often, dislocation occurs in industrial accidents, road accidents and falls from a height. When rolling up, isolated damage is usually observed, with other mechanisms of injury, a combination with fractures and dislocations of the bones of the skeleton, open wounds, chest damage, blunt abdominal trauma and TBI is possible. The treatment is carried out by orthopedic traumatologists.
The ankle joint is a complex block–shaped joint formed by three bones: the talus, fibula and tibia. The lower surface of the epiphysis of the tibia is attached to the upper part of the talus bone. The outer ankle, which is a continuation of the fibula, as well as the inner ankle, formed by the distal part of the tibia, cover the talus from the sides, forming a kind of fork that restricts the mobility of the joint laterally. Movements in the joint are carried out mainly in the frontal axis (extension and flexion of the foot). At the same time, despite the fork limiting the joint, there is also slight mobility in the sagittal direction (abduction and reduction of the foot).
The bones are held by the articular capsule and ligaments located on the lateral surfaces of the g/foot joint. On the outer surface is the calcaneal fibula, as well as the posterior and anterior talus-fibular ligaments. Damage to these ligaments occurs when the foot is turned inside. On the inner surface of the g / foot joint there is a deltoid ligament, which can be damaged when the foot is turned outward. The mechanism of bone damage is similar to the mechanism of ligament damage, however, more intense exposure is required for the occurrence of fractures of the shin bones and fractures.
There are four types of dislocations and subluxations of the ankle joint:
- External. The most common. Usually combined with a fracture of the outer ankle.
- Internal. As a rule, it is observed in combination with a fracture of the inner ankle.
- Rear. It is usually combined with a fracture of the posterior edge of the tibia.
- The front one. It is rarely observed, it can be combined with various joint injuries and a fracture of the lower third of the tibia.
A patient with a dislocated ankle joint complains of sharp pain. Significant swelling and cyanosis of soft tissues are detected in the joint area. Bruising is possible. With subluxations, moderate deformation is determined, with complete dislocations, a gross violation of anatomical relations is observed. Support is impossible. Palpation is sharply painful, with fractures, crepitation and pathological mobility can be determined. With subluxations, movements are sharply limited due to pain, with complete dislocations they are impossible, when trying passive movements, springy resistance is revealed.
With subluxations and especially with ankle dislocation, severe combined injuries often occur: two- and three-ankle fractures, rupture of the inter-tibial syndesmosis, multiple tears and ruptures of ligaments, as well as ruptures of the joint capsule. With improper or untimely treatment, such injuries can lead to serious consequences in the form of a violation of the support, constant pain when walking and the development of arthrosis of the ankle joint.
Diagnostic measures in case of suspected ankle dislocation are carried out by an orthopedic traumatologist. A preliminary diagnosis is established on the basis of anamnesis and external examination. To clarify the nature of the damage, an ankle X-ray is performed. According to the indications, MRI and CT of the ankle joint are prescribed.
If this damage is suspected, it is strictly forbidden to attempt self-correction. It is necessary to fix the leg with a splint, apply cold to the damaged area and immediately deliver the patient to a specialized med. institution. In the department of traumatology and orthopedics, a closed reduction is performed and a plaster is applied with mandatory subsequent X-ray monitoring. After five days, the X-rays are repeated to make sure there is no secondary displacement, the plaster is circulated. The period of immobilization is determined by the type of damage.
Two unsuccessful attempts at closed reduction, as well as the inability to keep the fragments in the correct position, are indications for surgical treatment. Depending on the nature of the injuries, along with open reduction, osteosynthesis of the posterior edge of the tibia, restoration of distal inter-tibial syndesmosis, osteosynthesis of the outer ankle with a plate, osteosynthesis of the outer and /or inner ankle with screws, as well as transarticular fixation of the ankle joint with spokes can be performed. In the postoperative period, physical therapy and thermal procedures are prescribed.
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