Background
Displaced ankle fractures need prompt manipulation for pain and soft tissue compromise. We describe a gravity assisted technique which successfully reverses the fracture displacement without the need for additional personnel or equipment.
Technique
With adequate analgesia (opioids) and inhalation anaesthetics such as nitrous oxide + oxygen (Entonox, BOC Healthcare, Manchester, UK) or methoxyflurane (Penthrox Medical Developments International Limited, Victoria, Australia), the patient is encouraged to lie on the side opposite to the displacement, with the lower leg hanging off the end of the couch or propped up on firm supports (Figures 1 and 2). For the more common externally rotated lateral displacement, the patient lies comfortably supported with the injured side facing up. Similarly for posterior displacements, the patient is asked to lie prone. In a cooperative patient, the gravity assisted relocation of displacement is noted within about 5-10 minutes. Very gentle manipulation may be additionally utilised when a moulded plaster is applied without the need for an assistant. This technique has been successfully employed in many patients with Lauge-Hansen injury types: supination-external rotation, pronation-abduction and pronation-external rotation injuries.
Figure 1. Lateral position of the patient.
Figure 2. Lateral position of the leg-ankle reduction noted.
Figure 3. Pre-reduction radiographs.
Figure 4. Post-reduction radiographs.
Discussion
Though Stimson’s gravity method for the relocation of shoulder and hip joint dislocations has been proposed, similar application for ankle fracture dislocations is not reported. The commonly practised Quigley’s manoeuvre1 and various modifications2-4 require additional equipment and techniques. Our gradual reduction technique involves less discomfort to the patient and minimal manipulation of the fracture. Additionally, it is performed by a single practitioner while being easily reproducible and useful in all patients irrespective of body habitus. Our technique does not apply to noncompliant, polytrauma or open fracture patients and supination-adduction injuries.
References
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