Single Provider Reduction and Splinting of Displaced Ankle Fractures

Abstract

Ankle fractures are commonly treated by orthopaedic surgeons and often require manipulative reduction. This can be painful for the patient and frequently uses 2 or more providers. Intra-articular injection of local anesthetic into the ankle joint precludes the need for conscious sedation (intravenous narcotics and benzodiazepines, propofol, or ketamine). By combining an ankle block with a modification of the classic ankle fracture reduction technique described by Quigley 1959, a single provider can effectively perform a manipulative reduction and splinting of an ankle fracture without conscious sedation.

Intra-articular Hematoma Block Compared to Procedural Sedation for Closed Reduction of Ankle Fractures

“…This also supports the notion that technique is more important than form of analgesia in obtaining a reduction. Orthopedic surgery residents performed ankle reductions using a modified Quigley's technique, which was described by Alton et al 2 On occasion, when an assistant was available, the technique was modified. The assistant replaced the role of the intravenous pole and held the leg under the thigh and by the great toe, allowing the knee to flex.…”

Effectiveness of the Taut-Line Hitch Knot in Reducing and Splinting Lower Extremity Fractures

“…1 This technique has been modified and applied to the acute setting of fracture reduction. 2 One criticism of the technique has been the inability to flex the knee while the limb is suspended. As such, a modification of the technique has been described relying on a line made of kerlex or stockinette tied to the hospital bed, leading to flexion of the knee and, thereby, relaxation of the gastrocsoleus complex to aid in reduction.…”

Fulcrum-assisted Ankle Reduction Maneuver

“…This issue has opened the door for potential maneuvers that providers can perform by themselves. One such technique, described by Alton et al7 describes a modification of Quigley’s maneuver to reduce displaced ankle fractures. With this technique the provider can apply a splint and apply the correct molds while the Quigley maneuver is performed using an IV pole to help keep the ankle reduced in a splint.…”