Wilderness Medical Society snowmass 2005 Page 206
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H. Ankle: Most commonly associated with fractures, the dislocated ankle is obviously
deformed and often manifests crepitus. Reduce the deformity as much as possible as
necrosis of tight, stretched overlying skin is a danger. Ordinarily, this is not difficult
because of the gross instability resulting from associated fractures. Hold the forefoot and
allow the remainder of the extremity to act as the counter-traction. Improved alignment of
the ankle dislocation results without much additional effort. Gentle traction of the heel
and foot also helps. Immobilize with a splint, and carry the patient out.
IV. GUIDELINES FOR EVACUATION
Deciding which injuries mandate premature termination of a trip, and how rapidly and by
what means evacuation will be performed is a function of both the type of trip and type of
injury. Urgent evacuation is indicated in: 1) open fractures, 2) injuries with vascular
compromise not alleviated by reduction, 3) spinal injuries with neurologic deficits, 4)
injuries associated with significant blood loss, major fractures (hip, femur, pelvis, injury
with deformity at the knee, ankle or elbow, and 6) major dislocation that cannot be
reduced. Evacuation is not needed for: 1) digit injuries and 2) minimal injuries to other
joints. With adequate splinting, delays in reaching definitive medical care often result in
no permanent harm.
