Management of Ankle Injuries in the Prehospital Environment: A Review of the Literature

Ankle fractures have traditionally been seen as low priority cases as they do not pose an immediate life threat. Ankle fractures have the potential to create long-term mobility consequences for a person if managed inappropriately. The objective of this study was to determine the most effective way to manage ankle injuries in the prehospital environment. Methods A literature search was conducted of the medical related electronic databases, Ovid preMedline, Medline, Cinahl, Cochrane CENTRAL, and EMBASE from 1980 to the end of May 2013. A previously published prehospital search filter was used in each of the databases including additional keywords “fracture”, “ankle”, “ankle injuries”, “bone fractures”, and “sprains and strains”.  Articles were included if their primary aim was to examine the appropriate management of ankle fractures in the prehospital environment. The references of retrieved articles were also reviewed. Articles were excluded if they were not written in English. Results There were 531 articles located in the search. After reviewing the articles three were determined to meet the inclusion criteria. One article was set primarily in the emergency department but also included prehospital management. The remaining two articles were set in the prehospital setting. The findings suggest there is a defined set of questions to ask and specific assessment criteria for a patient with an ankle injury to determine its potential severity.  Where there is neurovascular compromise anatomical realignment should be attempted. Conclusion A thorough initial assessment and good basic management by prehospital care providers is essential to assist in decreasing delays to definitive treatment for patients with suspected ankle fractures, dislocations or fracture/dislocations. Further research is needed to determine to most effective management strategies in order to achieve optimal outcomes for patients with ankle injuries.