Ankle Dislocation in Armageddon

Unlike other dislocations which usually only involve a bone moving out of joint, ankle dislocations are a bit more complex.  There are actually two places that the dislocation may occur, and unfortunately for us, they look quite similar.  The dislocation may separate the foot from the ankle (the subtalar joint), or it may involve the ankle joint itself.  Regardless of the specific location, the dislocations are managed the same. 

Unfortunately, an ankle dislocation is often accompanied by fractures around the joint as well.  However, this does not alter treatment; the presence or absence of fractures, even compound fractures, doesn’t affect the necessity of applying traction to relocate and realign the bones.  The technique is the same.

This is going to hurt.  Anesthetics, if available, will be greatly appreciated.

The following instructions are a direct quote from Survival and Austere Medicine, 3^rd Edition:

Apply firm traction along the axis of the leg to the forefoot, while an assistant holds the leg at the knee and provides traction in the opposite direction.  Relocation will often correct with a ‘clunk’.  Dislocations with fractures may produce a grating sensation with no clear end-point.  If this occurs continue applying traction until the foot is aligned with the leg.

Depending on age, the ankle and foot will need to be immobilized for 4-6 weeks.  Children heal faster than adults and the elderly.

If you are dealing with a compound fracture as well—basically if the skin was broken and the joint is open, you not only need to apply traction, but the wound must be irrigated thoroughly.  This means several quarts of boiled water.  In addition, the patient should be immediately started on a broad-spectrum antibiotic. 

Links to related posts:

Shoulder Dislocations in Doomsday

Survival and Austere Medicine, 3^rd Edition

Wound Cleaning

Suturing

References:

Survival and Austere Medicine, 3^rd Edition, 2017, 178.

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