title: Initial management of closed fracture-dislocations of the ankle.
abstract: BACKGROUND
  Immediate management of closed fracture-dislocations of the ankle requires urgent reduction and immobilisation of the ankle prior to definitive surgery.
  
  
  METHODS
  The management of 23 patients attending the accident and emergency department of a district general hospital with this type of injury were reviewed retrospectively.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The necessary urgent reduction and splintage is being delayed in some cases because of inadequate injury recognition, inappropriate triage categorisation and unnecessary radiographs.
authors.affiliation: Department of Accident and Emergency Medicine, Kingston General Hospital, Surrey, UK. becky_payne@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: Payne
authors.forename: J C
authors.initials: JC
authors.lastname: Kinmont
authors.forename: S M
authors.initials: SM
authors.lastname: Moalypour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D004632:Emergency Medical Services; D005260:Female; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007103:Immobilization; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D013165:Splints; D014218:Triage