We report the results of treatment in eight patients who had
posteromedial dislocation of the ankle without fracture. The ages of seven
of the eight patients ranged from twenty-three to thirty-six years. Four
patients had increased generalized ligamentous laxity. One-half of the
injuries were sustained during athletic competition. The mechanism of
injury appeared to be forced inversion of the foot when it was maximally
plantar flexed and axially loaded. Five of the eight patients had an open
injury, and four of the five patients had an associated injury to the
anterolateral neurovascular structures. No patient had an injury to the
distal tibiofibular ligaments or to the syndesmosis. The three patients who
had a closed dislocation achieved good long-term functional and
roentgenographic results after closed reduction and immobilization. The
patients who had an open injury that was treated by anatomical repair of
the disrupted lateral ligaments at the time of initial debridement also
achieved good long-term functional and roentgenographic results. It does
not appear to be necessary to repair the deltoid ligament. In one patient
who had an open dislocation and in whom the lateral ligaments were not
repaired, moderate instability of the ankle resulted and degenerative
changes developed in the joint.