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Abstract: If the force on the ankle joint exceeds its own capacity, it will easily cause ankle dislocation. If the ankle dislocation is not treated in time, it will cause sequelae such as ankle instability, traumatic ankle arthritis, and even ischemic necrosis of the foot due to dorsalis pedis artery injury in severe cases. In this case, the patient was admitted to the hospital because of ankle dislocation. After timely surgery and rehabilitation, the ankle joint was successfully repositioned and the ankle joint function was gradually restored.
Basic information】Female, 32 years old
Disease Type】Ankle dislocation, open internal ankle fracture, distal fibula fracture, ankle sprain
Hospital】The First People’s Hospital of Jiujiang City
Date of Consultation】March 2022
Treatment plan】Surgical treatment (open right ankle dislocation emergency debridement + ankle dislocation repositioning + brace external fixation) and rehabilitation training
Treatment period】2 weeks in hospital, 6 weeks after surgery, the external fixation brace was removed.
Results】The ankle joint was successfully repositioned and the ankle joint function was gradually restored.
I. Initial consultation
The patient complained of slipping on an electric bicycle 2 hours before admission and using her right foot, which was wearing high heels, to support the ground, but failed to do so. She was admitted to our emergency surgery department by her relatives and friends. X-ray of the right ankle joint (standard ankle film could not be taken due to the patient’s pain and ankle deformity) showed: ankle dislocation, open internal ankle fracture, distal fibula fracture and ankle sprain (Figure 1). The skin temperature of the toes of the right foot was lower than that of the left foot, and a bone rubbing sensation could be detected in the inner and outer ankle.
II. Treatment history
In view of the active bleeding of the right ankle trauma, the skin temperature of each toe of the right foot was lower than that of the left foot, and the pulsation of the dorsalis pedis artery was not obvious. In order to avoid ischemic necrosis of the right foot due to prolonged compression of the dorsalis pedis artery by the ankle dislocation, the preoperative preparation was immediately improved, and the open right ankle dislocation was urgently cleared under lumbar anesthesia + ankle dislocation repositioning + stent external fixation. After successful anesthesia, the patient was placed in a flat position, the skin of the surgical field was routinely disinfected with iodophor, towels were laid, the wound surface was flushed with plenty of saline, the traumatic underwear fibers and other dirt and necrotic tissues were removed, the ankle dislocation was repositioned by manipulation, and the external fixation brace was fixed to maintain the stability of the ankle joint. Postoperatively, the patient was treated with infection prevention, rehabilitation training and prevention of deep vein thrombosis in the lower limb.
III. Treatment effect
The patient had no right foot numbness and other discomfort, and all toes of the right foot moved freely without symptoms of ischemic necrosis. There was no significant discomfort in the patient’s right foot without weight-bearing exercise with crutches. The patient was discharged from the hospital with good wound healing 2 weeks after surgery, and was instructed to follow up with the orthopedic clinic for treatment. At 6 weeks after surgery, the external fixation brace was removed and replaced by external fixation with a brace, and ankle rehabilitation training was performed. The ankle dorsiflexion function improved at 8 weeks postoperatively. It is proposed to review the X-ray 3 months after surgery and decide whether to remove the crutches according to the fracture healing.
IV. Precautions
After the treatment, the patient gradually recovered the function of the ankle joint movement, which is gratifying as the attending physician. Patients with ankle sprains are relatively common, but some patients do not take it seriously and think that ankle sprains are just fine. Due to the different forces that cause ankle sprains, it is possible that the process of ankle sprains may only cause ligament strains and not ankle dislocations, or it may only tear the ligaments and cause ankle subluxations, but severe violence can also lead to ankle dislocations and fractures of various orientations and degrees. Therefore, patients with ankle sprains should seek medical attention promptly and have positive and lateral ankle radiographs taken if necessary. If there is no ankle dislocation or fracture on the X-ray, it should not be taken lightly and should be fixed with an elastic bandage or ankle brace. For patients with repeated ankle sprains or those who feel ankle instability going up and down stairs, ankle MRI should be performed to find out if there is ankle ligament rupture, and if necessary, ankle arthroscopy should be performed to repair and rebuild the ankle joint to restore stability.
V. Personal insight
The love of beauty is common, and women are fond of high heels, but wearing high heels will cause the body’s center of gravity to change. Walking up and down stairs or on uneven surfaces will easily lead to ankle sprains, and if the violence of the sprain exceeds the strength of the ankle ligaments and joint capsule, it will lead to ankle dislocation. The ankle joint is closely related to various movements of the lower extremities, so on certain occasions, such as biking, going up and down stairs, and uneven surfaces, it is best to wear flat heels. Men, on the other hand, should control their weight to avoid ankle dislocation caused by excessive force on the ankle joint during sports injuries.