In suspected ankle fracture-dislocation in the field, what is recommended?

• A. Immobilize in the position found and transport
• B. Realign to reduce fracture before transport
• C. Apply heat and massage
• D. Bear weight during transport

Answer: (A)

When you’re in the field with a suspected ankle fracture-dislocation, the priority is to protect the limb and prevent further injury until definitive care is available. Immobilizing the ankle in the position found and transporting the patient is the safest approach because moving or trying to realign the ankle outside a proper medical setting can cause additional soft tissue damage, nerve or vessel injury, and worsen the dislocation. Realignment requires imaging, analgesia, and controlled conditions the ED provides, not the field.

Secure a rigid splint that spans from just below the knee to the foot, with padding to avoid pressure points, and immobilize the ankle, foot, and lower leg as a unit. Check distal neurovascular status before and after splinting and document any changes. If possible, elevate the limb to reduce swelling, but never alter the position of the fracture. Do not apply heat or massage, and avoid bearing weight on the injured leg. Prompt transport to the hospital for imaging and definitive treatment is essential.