[3] If the ankle–brachial pressure index is less than 0.9, CT angiography is recommended to detect blood vessel injury.

[2] More recently, the FAST-D protocol, assessing the posterior tibial and dorsalis pedis arteries for a ‘tri-phasic wave pattern’ with ultrasound, has been shown to be reliable in ruling out significant arterial injury.

[8] If the joint remains dislocated, reduction and splinting is indicated;[4] this is typically carried out under procedural sedation.

[2] If signs of arterial injury are present, immediate surgery is generally recommended.

[2] Descriptions of this injury date back to at least 20 BC by Meges of Sidon.

[12] As the injury may have self-reduced before arrival at hospital, the diagnosis may not be readily apparent.

[2] If the ABI is greater than 0.9 repeated physical exams over the next 24 hours to verify good blood flow may be sufficient.

[2] More recently, the FAST-D protocol, using ultrasound to assess the posterior tibial and dorsalis pedis arteries for a ‘tri-phasic wave pattern’, has been shown to be reliable in ruling out significant arterial injury.

[8] They may be divided into five types: anterior, posterior, lateral, medial, and rotatory.

[2] Initial management is often based on Advanced Trauma Life Support.

[4] Reduction can often be done with simple traction after the person has received procedural sedation.