The occurrence of ankle dislocation without accompanying fractures is an extremely rare event [ 1 , 2 , 3 , 4 ]. Moreover, the gold standard treatment for this condition has not yet been established.
In the present report, we describe a case of ankle dislocation that occurred without associated fractures in a young athlete. The patient was an elite basketball player in high school and had injured her right ankle during a contact play in basketball.
To facilitate early return to basketball, external fixator and ligament repair with suture tape augmentation to repair the damaged anterior talofibular ligament ATFL , calcaneofibular ligament CFL , and deltoid ligament DL. A year-old woman fell and injured her right ankle during contact play in basketball. She was immediately transported to our hospital, where her ankle was found to be swollen and deformed.
Plain X-ray revealed tibiotalar dislocation in the medial direction without any fractures Fig. Plain x-ray image obtained at the first visit to our hospital. The tibiotalar joint was found to be dislocated in the medial direction without any fractures. Emergency washout and debridement were performed with primary closure of the wound, and reduction using an external fixator under lumbar anesthesia was performed on the night of the injury.
The postoperative computerized tomography CT also revealed no malleolar fractures and syndesmosis injury. The operation was performed under lumbar anesthesia. First, the external fixator was completely removed; the varus and valgus stress views were confirmed using fluoroscopy.
Subsequently, medial and lateral instabilities of the ankle joint were revealed, and ligament repair was performed. We placed a proximal 4. The superficial and deep DLs were found to be damaged in the mid portion. Suture tape augmentation was subsequently performed. The 4. Another 3. The varus and valgus stress views and anterior drawer view on x-ray revealed adequate stability of the ankle joint Fig.
Adequate stability of the ankle joint was observed. Pure ankle dislocations are extremely rare. In their systematic review, Wight et al. Most pure ankle dislocations are closed dislocations [ 7 ] caused by high-energy trauma, such as motorcycle accidents, sports injuries, and falls from heights [ 8 ]. This case was an extremely rare open dislocation with 4. The patient fell and injured her right ankle during contact play in basketball.
We considered that the mechanism underlying the injury was axial loading by landing with plantarflexion and ankle inversion, similar to previous reports [ 9 , 10 ]. Furthermore, because there were no fractures, it is possible that some traction force, joint and ligamentous laxity, and other factors may have been related to the mechanism. In fact, the patient had a history of one instance of sprained right ankle.
Moreover, some reports [ 8 ] [ 7 ] have mentioned predisposing factors contributing to the pathogenesis of pure ankle dislocations, such as internal malleolus hypoplasia, ligamentous laxity, weak peroneal muscles, and repetitive ankle sprains.
Early reduction is important to achieve good clinical outcomes. Sayit et al. The advantage of external fixation is the ease and safety of assembly at any time, even in an emergency situation such as in the present case.
It also provides firm ankle joint fixation while improving swelling. In this case, we considered that external fixation was better than casting because severe ankle swelling and open wound were observed.
There was a concern of neurovascular complication and infection after casting. Although external fixation is an easy approach to achieve strong fixation, long-term use can be more uncomfortable for the patient compared with casting. The necessity of repairing ruptured ligaments is disputable. In the study reported by Wight et al. Distefano et al.
In contrast, Colville et al. In the present case, ligament repair with suture tape augmentation was performed because the patient was an elite athlete and wanted a swift recovery to return to playing basketball.
This technique is a simple and quick procedure that can achieve adequate stability of the ankle joint. An effect similar to the internal brace can be expected by creating tibiocalcanear and tibiotalar anchor bridges with suture tape. This facilitates early range-of-motion training and prevents ankle contracture. In reference to strength of suture augmentation, Viens et al. With the distal anchor is temporarily inserted, the tension of the suture tape can be checked and fine adjusted while moving the ankle joint under fluoroscopy.
After that, the final insertion can be performed. There is no concern about postoperative ankle joint range-of-motion limitation by over-tensioning. Rivera et al. These complications can reduce performance levels for high-level basketball players; thus, we aimed to prevent these complications in the present case. For your safety, do not drive or operate any machinery that could be dangerous. Wait until the medicine wears off and you can think clearly and react easily.
Put ice or a cold pack on your ankle for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days when you are awake. Put a thin cloth between the ice and your cast or splint.
Keep your cast or splint dry. Follow the cast care instructions your doctor gives you. If you have a splint, do not take it off unless your doctor tells you to. Be safe with medicines. Read and follow all instructions on the label. If the doctor gave you a prescription medicine for pain, take it as prescribed. If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
Prop up your leg on pillows in the first few days after the injury. Keep the ankle higher than the level of your heart. This will help reduce swelling. Do not put weight on your ankle unless your doctor tells you to. Use crutches to walk. Wiggle your toes often to reduce swelling and stiffness. For example, call if: You have trouble breathing. You passed out lost consciousness. You have chest pain, are short of breath, or cough up blood. Call your doctor or nurse call line now or seek immediate medical care if: You have new or worse nausea or vomiting.
If the ankle dislocation also involved a bone fracture, surgery is often required to relocate the bones. If the ankle cannot be reduced to return it to its normal alignment, surgery may be needed to realign the joint.
Ankle Dislocation An ankle dislocation occurs when a significant amount of force causes the bones in the ankle joint to move out of their proper alignment. Individuals who suffer ankle dislocation typically experience these symptoms: Intense pain at the time of injury Swelling and bruising at the ankle joint A visible deformity of the ankle joint Difficulty moving the foot and ankle Inability to bear weight on the injured leg An ankle dislocation is a serious injury and warrants immediate medical attention.
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