From the Guidelines
The management for a 38-year-old female with a reduced ankle dislocation should prioritize functional support over immobilization, with the use of an ankle brace for 4-6 weeks, as it shows the greatest effects compared to other types of functional support 1. The patient should follow the RICE protocol (Rest, Ice, Compression, Elevation) and take pain medications such as ibuprofen 400-600mg every 6-8 hours or acetaminophen 500-1000mg every 6 hours as needed for pain. Some key points to consider in the management of this patient include:
- A follow-up X-ray within 7-10 days to confirm proper alignment
- Physical therapy after the initial 4-6 weeks, focusing on range of motion exercises, strengthening, and proprioception training
- Progressive weight-bearing, from non-weight-bearing to partial and then full weight-bearing as healing progresses
- Monitoring for complications such as post-traumatic arthritis or chronic instability Recent evidence suggests that a short period of immobilization (<10 days) can be beneficial in decreasing pain and oedema, and improving functional outcome 1. However, the primary focus should be on functional support and exercise strategies, as they result in better outcomes compared to immobilization alone 1. The recovery time for this patient can vary, but typically takes around 8-12 weeks, depending on the severity of the injury and associated ligament damage.
From the Research
Management of Ankle Dislocation
- The initial management of ankle dislocation includes reduction of the dislocated joint to its normal anatomical position, referred to as reduction 2.
- Urgent reduction and immobilisation of the ankle are required prior to definitive surgery 3.
- The management of ankle dislocation may involve history taking and physical assessment, reduction of the dislocation and splinting of the ankle under procedural sedation, monitoring during and after procedural sedation, and radiological imaging 2.
Recovery Time
- The mean period of immobilisation for ankle dislocation is just over 6 weeks (range 2-16 weeks) 4.
- Most patients with ankle dislocation have good functional outcomes, with the most common long-term complaint being decreased ankle range of motion (18%) 4.
- Ankle instability is rare (2.6%) and not influenced by acute ligament repair 4.
Treatment Options
- Nonoperative treatment is used in 46% of patients with ankle dislocation, while ligamentous repair is described in 26% of patients 4.
- Temporizing external fixation may be used as an alternative to splinting in cases of ankle fracture-dislocation, with a lower risk of complications such as loss of reduction and skin necrosis 5.
- Delayed open reduction and internal fixation may be used to treat neglected fracture dislocations of the ankle, with good clinical outcomes possible if anatomic reduction is achieved 6.