Bimalleolar and trimalleolar fractures will usually require fixation but often require manipulation while awaiting swelling to resolve before surgery.
- Usually require sedation
- Patient’s knee flexed over examination table (or them lying in bed if more practical)
- Ask assistant to apply stockinette and webril
- Reducing ankle fracture-dislocation
- Grasping their hindfoot, apply traction as if you are ‘taking their shoes off’, in order:
- Correct posterior subluxation by lifting heel anteriorly
- Correct external rotation
- Repositioning ankle fracture which is not dislocated
- Ask assistant to apply plaster first (wet)
- Much less pressure is required – just move the ankle joint into the correct place while plaster dries as below
- Ensure the ankle is held in the correct position – note it is a very unstable fracture and will fall out of place with gravity if not supported properly
- Ensure ab/adduction is correct (i.e. ankle is in line with lower leg)
- Ensure posterior subluxation is correct (hold ball of foot anteriorly or hold foot up with great toe to ensure heel is in line with back of shin and ankle is at 90Ëš)
- Tweak the external rotation of ankle to match other side (look at position of the toe in line with the knee)
- Hold in place while below knee backslab is applied