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Ankle Dislocation Nursing Guide

Content reviewed by Ann Dietrich, MD, FAAP, FACEP.

Ankle Dislocation Etiology and epidemiology 

Ankle dislocations are a common emergency department (ED) injury, often occurring alongside fractures. There are two primary types: 

  • True dislocation without fracture: Rarely occurs and involves torn or strained ligaments or muscles. 
  • Fracture-dislocation: Much more common, where the dislocation is accompanied by fractures of the ankle bones (Wight et al., 2017). 

Ankle Dislocation Risk factors 

  • Children and adolescents: Higher risk due to increased activity levels and susceptibility to traumatic injuries. 
  • Young males: More prone due to higher exposure to high-impact activities. 
  • Postmenopausal women: Increased risk for fractures with dislocation due to osteoporotic changes. 

Types of ankle dislocation 

  1. Anterior dislocation: Occurs when the foot is forced forward at the ankle joint, usually due to forced dorsiflexion or a posterior force on the tibia with a fixed foot. 
  2. Lateral dislocation: Results from forced inversion or eversion of the ankle and is often accompanied by malleolar or distal fibular fractures. 
  3. Posterior dislocation: The most common type, where force drives the foot backward, causing the talus to move posteriorly relative to the tibia. Often associated with syndesmotic disruption or lateral malleolar fracture (Elsayed et al., 2017). 
  4. Superior dislocation: Occurs when a force drives the talus upward into the joint, commonly from a fall from height. Requires careful evaluation for spinal injuries and calcaneal fractures. 

Common causes:

  • Trauma 
  • Joint laxity 
  • History of peroneal muscle injury (Elsayed et al., 2017) 
  • Neuromuscular disorders (e.g., muscular dystrophies, myopathies) 

Diagnosis:

Diagnostic evaluation of ankle dislocation includes: 

  • X-rays: Anteroposterior, lateral, mortise, or oblique views. 
  • Pre- and post-reduction imaging: Essential to confirm proper alignment post-reduction. 
  • CT scan: Used if X-rays are not sufficient. 
  • MRI: To evaluate possible ligament or tendon damage. 

Management 

Immediate treatment 

  • Immobilization: Essential immediately following the injury. 
  • Prompt reduction: Reducing the dislocation immediately minimizes the chance of complications and permanent damage. 
  • Procedural sedation and intra-articular hematoma block (IAHB): Used to manage pain during reduction (MacCormick et al., 2018). 
  • Reduction technique: Performed with the knee in flexion to reduce tension on the Achilles tendon. 
  • Post-reduction X-rays: Confirm proper alignment after reduction. 

Post-reduction care 

  • Splinting: Usually required for about six weeks to stabilize the ankle (Wight et al., 2017). 
  • Crutches/walking aids: Use crutches if the ankle cannot bear weight; transition to a cane if needed. 
  • Pain management: 
  • Acetaminophen or NSAIDs: For pain relief in the first 24 to 48 hours post-reduction. 
  • Opioids and anxiolytics: May be required for acute pain management before or immediately after reduction. 
  • Surgical intervention: Necessary if closed reduction fails, in cases of recurrent dislocation, or if there are complications such as tendon entrapment. 

Ankle Dislocation Nursing Care Plan

Nursing considerations 

Assessment 

Assess the individual for: 

  • Inability to bear weight: Often accompanied by intense pain and visible deformity. 
  • Neurological symptoms: Weakness, tingling, or numbness near the injury. 
  • Swelling and bruising: Particularly around the ankle joint and malleolus. 
  • Ligamentous disruption: Detected by tenderness along the joint line. 

Nursing diagnoses 

  • Activity intolerance 
  • Acute pain 
  • Impaired physical mobility 
  • Altered tissue perfusion 
  • Self-care deficit 
  • Risk for infection 
  • Anxiety 
  • Peripheral neurovascular dysfunction 

Interventions 

  • Pain management: Administer prescribed analgesics and utilize non-pharmacological strategies. 
  • Ice application: Apply ice packs to reduce swelling and pain. 
  • Emotional support: Offer reassurance, especially in the case of traumatic injuries. 
  • Range-of-motion exercises: Encourage and assist with exercises as prescribed to prevent and reduce stiffness. 
  • Monitoring: Regularly assess vital signs, neurovascular status, and watch for signs of complications like compartment syndrome. 

Expected outcomes 

  • Maintained tissue perfusion 
  • Restored range of motion (ROM) 
  • Effective pain management 
  • Prevention of complications: Such as infection, neurovascular damage, and chronic instability. 

Individual/caregiver education 

  • Injury and treatment understanding: Educate on the diagnosis, treatment plan, and the importance of adhering to care instructions. 
  • Use of mobility aids: Proper use of crutches or walkers to ensure non-weight bearing on the injured ankle. 
  • Healing time: Healing time can vary based on the fracture, procedure, and comorbidities.  
  • Signs of complications: Instruct on recognizing increased pain, swelling, numbness, or signs of infection. 
  • Follow-up care: Emphasize the importance of attending follow-up appointments and adhering to prescribed physical therapy to prevent recurrence. 

ICD-10 code for ankle dislocation 

  • S93.03XA — Dislocation of ankle joint, initial encounter 

FAQs

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2024

References 

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