We report an open pure ankle dislocation without fracture in a 61-year-old man after a heavy load struck his thigh. Preoperative computed tomographic angiography (CTA) demonstrated entrapment of the posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons together with the tibial neurovascular bundle within a widened tibiofibular syndesmosis. Given irreducibility and risk to the bundle, open reduction was performed with careful disengagement of the entrapped structures, followed by staged dynamic fixation of the syndesmosis. The patient returned to normal activity without pain or limitation of range of motion. Pure ankle dislocation with syndesmotic diastasis accompanied by diminished or uncertain distal neurovascular findings and/or irreducibility should raise suspicion for deep entrapment, for which early CTA may facilitate safer operative planning and help avoid iatrogenic injury from repeated manipulation. Level of Evidence: Level V, Case Report
Hagino et al. (Sat,) studied this question.