Initial management of closed fracture-dislocations of the ankle

Abstract

Immediate management of closed fracture-dislocations of the ankle requires urgent reduction and immobilisation of the ankle prior to definitive surgery. The management of 23 patients attending the accident and emergency department of a district general hospital with this type of injury were reviewed retrospectively. Paramedic reduction was attempted in 1 of the 22 patients brought by ambulance. Triage categorisation was inappropriate in 14 patients. Unnecessary pre-reduction radiographs were obtained in 8 patients. Reduction was initially inadequate in 2 patients, and no post-reduction splintage was applied in a further 2 patients. Recording of skin and neurovascular status was inadequate in the majority of the patient's notes. The necessary urgent reduction and splintage is being delayed in some cases because of inadequate injury recognition, inappropriate triage categorisation and unnecessary radiographs.