Question 1

Why does ankle dislocation require such urgent reduction?

Accepted Answer

Ankle dislocation is ORTHOPEDIC EMERGENCY requiring reduction within 6 HOURS (ideally within 1-2 hours if skin tenting present). REASONS FOR URGENCY: (1) SKIN NECROSIS: Dislocated talus pushes against ankle skin from inside, stretching skin tight (skin tenting). Skin has limited blood supply - tight stretch compresses blood vessels. Skin can die (necrosis) within 4-6 hours of continuous pressure. Skin necrosis leads to: Open wound requiring skin grafting. High infection risk (bone exposed). Worse long-term outcome. Prolonged hospital stay. (2) NEUROVASCULAR INJURY: Dislocated bones stretch or compress nerves (tibial nerve, deep peroneal nerve) and blood vessels (dorsalis pedis artery, posterior tibial artery). 10-20% of ankle dislocations have neurovascular injury at presentation. Prolonged pressure increases risk of: Permanent nerve damage (numbness, weakness, foot drop). Vascular injury causing foot ischemia (tissue death if blood flow not restored within 6-8 hours). (3) INCREASED PAIN: Dislocated joint causes severe pain - reduction provides immediate pain relief. (4) EASIER REDUCTION: Early reduction easier (before severe swelling makes reduction technically difficult, may require open surgery). REDUCTION TIMELINE: SKIN TENTING PRESENT (pale white stretched skin) - reduce within 1-2 HOURS maximum (skin necrosis imminent). NO skin tenting but obvious dislocation - reduce within 6 HOURS (standard emergency timeframe). Delayed reduction (greater than 6 hours) - higher complication rate but still better than leaving dislocated. PRE-HOSPITAL: Ambulance staff may attempt reduction if transport time long (greater than 1 hour to hospital) and skin tenting present. Otherwise, splint in position found, transport urgently. HOSPITAL: Emergency department performs closed reduction under procedural sedation immediately upon arrival (do NOT wait for X-rays if obvious dislocation - X-rays after reduction).

Question 2

What is compartment syndrome and why is it a risk after ankle dislocation?

Accepted Answer

Compartment syndrome is LIMB-THREATENING EMERGENCY where swelling inside leg muscle compartments causes pressure buildup, compressing blood vessels and nerves, leading to muscle and nerve death if not treated urgently. ANATOMY: Lower leg has 4 compartments (anterior, lateral, superficial posterior, deep posterior) enclosed by thick fascia (non-stretching connective tissue). Each compartment contains muscles, nerves, blood vessels. WHY ANKLE DISLOCATIONS CAUSE COMPARTMENT SYNDROME: (1) HIGH-ENERGY TRAUMA - ankle dislocations usually from severe trauma causing muscle contusion, bleeding into compartments. (2) FRACTURES - associated fractures cause bone bleeding, adding fluid to compartments. (3) VASCULAR INJURY - temporary blood vessel disruption during dislocation then reperfusion after reduction causes inflammatory swelling. (4) DELAYED REDUCTION - prolonged dislocation increases swelling risk. INCIDENCE: 5-10% of ankle fracture-dislocations develop compartment syndrome (higher than isolated ankle fractures 1-2%). SYMPTOMS (THE 5 P's): (1) PAIN out of proportion - severe pain not improving with normal doses of pain medication. (2) PAIN with PASSIVE STRETCH - severe pain when toes passively stretched (stretch muscles in affected compartment). (3) PARESTHESIAS - numbness, tingling in foot (nerve compression). (4) PALLOR - pale foot (late sign, indicates arterial compromise). (5) PULSELESSNESS - absent foot pulses (very late sign, indicates severe ischemia). (6) PRESSURE - tense swollen leg compartments (palpable on examination). DIAGNOSIS: Clinical diagnosis (symptoms above) + compartment pressure measurement using needle manometer. Pressure greater than 30 mmHg diagnostic. Normal pressure less than 10 mmHg. TREATMENT: EMERGENCY FASCIOTOMY (surgery within 6 hours of diagnosis critical). Fasciotomy - long incisions through skin and fascia to release compartment pressure. All 4 compartments released (2 long incisions on leg). Wounds left open 3-7 days then closed secondarily or skin grafted. CONSEQUENCES if MISSED: Muscle death (ischemic contracture) - foot fixed in abnormal position, permanent disability. Nerve death - permanent numbness, weakness, foot drop. Amputation - in severe cases if muscle/tissue dies. Compartment syndrome is EMERGENCY within an emergency - requires high suspicion after ankle dislocation, urgent orthopedic review if suspected.

Question 3

Will I develop arthritis after ankle dislocation?

Accepted Answer

YES - post-traumatic ankle arthritis is COMMON long-term complication of ankle dislocation. 20-40% of patients develop ankle arthritis within 5-10 YEARS after ankle fracture-dislocation requiring further treatment (fusion or replacement). MECHANISM: (1) CARTILAGE DAMAGE during dislocation - violent displacement damages articular cartilage (joint surface). Cartilage cannot heal (no blood supply, no regeneration capacity). Damaged areas progress to arthritis over years. (2) FRACTURE through joint surface - ankle dislocations almost always have associated intra-articular fractures (fracture line crosses joint). Even perfect surgical reduction leaves cartilage injury at fracture line. (3) RESIDUAL MALALIGNMENT - if fracture heals slightly out of position (even 1-2mm), creates abnormal joint mechanics, accelerates cartilage wear. (4) CHRONIC INSTABILITY - ligament damage from dislocation may cause subtle chronic instability, abnormal loading pattern. RISK FACTORS for POST-TRAUMATIC ARTHRITIS: (1) Talar dome fractures (cartilage injury on talus) - 60-80% arthritis risk. (2) Pilon fractures (tibial plafond shattered) - 40-60% arthritis. (3) Malunion (fracture healed out of position) - 50-70% arthritis. (4) Delayed reduction (greater than 6 hours) - higher cartilage injury. (5) Severe initial cartilage damage visible on MRI or at surgery. (6) Smoking, diabetes - impair healing, increase arthritis risk. TIMELINE: Symptoms typically develop 2-5 years post-injury (sometimes 5-10 years). Early signs: Stiffness after rest. Pain with activity. Swelling after walking. X-ray changes (joint space narrowing, bone spurs). TREATMENT of POST-TRAUMATIC ARTHRITIS: Conservative first (physiotherapy, orthotics, injections, activity modification). If conservative fails - surgical options: (1) Ankle fusion (arthrodesis) - gold standard for end-stage post-traumatic arthritis, 90-95% pain relief but eliminates motion. (2) Total ankle replacement - preserves motion but higher failure rate, activity restrictions. PREVENTING POST-TRAUMATIC ARTHRITIS: (1) Anatomic reduction (perfect alignment) - reduces arthritis risk 30-50% vs malalignment. (2) Early surgery (3-7 days) for swelling to settle but before soft tissue problems. (3) Smoking cessation, weight optimization. (4) Physiotherapy to restore full ROM and strength. REALISTIC EXPECTATIONS: Even with perfect treatment, 20-30% develop arthritis (unavoidable cartilage injury from dislocation itself). Most patients have good function initially (1-5 years) then gradual decline. Long-term plan may include arthritis surgery eventually.

Medical Disclaimer

Ankle Dislocations (Emergency)

📖What is Ankle Dislocations (Emergency)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention