Industrial Accident

The Story
Patient is a 42 y/o caucasian male, presented to the ED with an amputated left great toe. The patient states that he works at a metal sheeting plant and that while loading sheets into the press, his left foot got caught underneath one of the presses and cut off his left toe. The patient was wearing steel toed boots, but the force of the press was so great, that it sliced through the steel toe, and subsequently his left great toe. Digits 2-5 luckily remained intact.

Treatment
Patient tetanus status was undetermined, so tetanus immunization was administered.

Copious amounts of sterile saline was used to flush the wound. Attention was then directed to the left hallux. The proximal phalanx of the hallux was all that was left distally. A rongeur was used to trim back the proximal phalanx so that proper skin closure could be attained. The distal end was also filed so as to not have any sharp edges or boney spicules present. The skin was resected in a fashion that resembled a fish mouth incision, and adequate closure was then properly achieved. On a side note, this procedure took place within the trauma bay. Patient will return to clinic for follow up.

Fibular Fracture

A weekend trip to the ice skating rink can be hazardous to your health.

28 year old African American female presented to clinic with a painful right leg. The patient stated she went ice skating 3 days ago and that a 12 year old boy fell on her right leg. Patient stated she went to the ED and they applied an ace wrap, crutches, and instructed her to ice her leg. Radiographs were taken and this is what was seen.

What we saw was a displaced, oblique, fibular fracture located in the distal end of the diaphysis of the right fibular. The fracture was closed with a 2 degree angular deviation of the distal fragment (Weber C) .Visibly the leg was inflammed and thus a posterior splint was applied with some compression using an ace wrap. The patient was given some medication for pain control and she was scheduled for surgery in 4 days.

In surgery the fracture was open reduced, and a fibular plate (BioMet) was applied with 6 points of fixation.

Patient is currently in the healing process and will follow up in 1 week.

Chronic Ishemic Leg

Patient is a 54 y/o diabetic male who was admitted to the hospital for shortness of breath. Patient has a history of smoking, hyperlipidemia, and hypertension. Upon physical examination a dependent rubor was observed in the right leg. Upon further examination, the right leg compared to the contra-lateral limb was cooler, and during the exam the patient stated that sometimes he feels cramps at the level of his right thigh. Patient was taken to the OR for an angiogram. Angiogram was conclusive and showed collateralization of vessels at the level of the distal femoral artery in correlation with occlusive disease proximal to that site. Patient will undergo bypass surgery tomorrow.


Major Risk Factors: Diabetes, Hypertension, Hyperlipidemia, Smoking.

45 y/o male with NIDDM was admitted to the hospital for polysubstance abuse. Podiatry was consulted for management of the large anterior venous stasis ulcer of the right leg. The wound measured 16cm x 14cm and had a fibrogranular base. Positive edema noted, No sinus tracking, no edema, no mal odor, and no erythema. Patients vitals were stable. Anerobic/Aerobic wound cultures were attained. The wound was irrigated and fibrous film over the wound was removed. Collagen matrix product was applied to the entire wound bed, then an Unna boot, followed by cast padding and Coban. Patient was visiting the podiatry clinic previously but did not show up for follow up appointments for at least 3 months. Will change dressings in 3 days.

Uncontrolled diabetes leads to OM.

One week ago a 66 year old diabetic male presented to clinic with ulceration at the plantar aspect of the right hallux. + Probe to bone and thus a bone biopsy was performed. Clindamycin was prescribed for the possible infection. Betadine and DSD was then applied to the wound.

Bone biospy results showed trabecular pattern consistent with osteomyelitis. Vascular consult was ordered to assess the blood flow to the toe and clearance for surgery was granted. Patient is scheduled for a hallux amputation of the right foot.

Previously the patient also had a below knee amputation of his left leg in 2006. Patient does not know what medications he takes for his diabetes and admits to not taking his meds consistently.

Navicular Fracture after 3 months.

Patient is a 27 y/o male who complains of foot pain that started approximately 3 months ago. Patient states that he injured his foot during vigorous running exercises and was treated for an ankle sprain. Radiographs were taken and show that a dorsal lip fracture of the right navicular is present. Dorsal lip fractures of the navicular are the most common type and represent roughly 47% of all navicular bone fractures.

Interesting observation during the clinical examination is the pes planus foot type exhibited by the injured limb. It is possible that the posterior tendon was compromised and surgical correction may be needed.

The patient is scheduled for a possible T-N fusion and follow up radiographs will be posted in the near future.

Case: 1st MPJ Implant Failure

Patient is a 69 year old African American female with complaints of a painful swollen toe. Patient stated that a few months prior she had been prescribed allopurinol and colchicine by her PCP for treatment of gout but the pain was still persisting. Upon taking radiographs of the affected foot we discovered an implant located within the proximal phalanx of the right hallux. Patient stated that she had foot surgery about 10-15 years ago for reasons she could not remember.







Patient was taken to surgery and the implant was removed. The joint was cleaned up, the void in the proximal phalanx was filled using Osteosponge, and a single K-Wire was then used to fixate.