Discusión entre pares: 25 yr old male foot runover by jpc mahine, mid foot fracture....

Rakesh Agarwal

25 yr old male foot runover by jpc mahine, mid foot fracture, calcaneum fracture with collapse of calcaneo cuboid joint. severe swelling with medial laceration.
treated in emergency with percutaneous k wire, limb elevated.
after wrinkle sign medial wound closed. pt taken for definitive surgery with calcaneo cuboid joint reconstruction, cuboid and calcaneum plating.

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  Alok Jain I would like to invite comment from Dr Michael Dujela....

  Hace 10 horas a través de móvil · Me gusta · 2
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  Aung Kyi Win Good job.

  Hace 6 horas a través de móvil · Me gusta · 1
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  Arvind Jain Looks like an orthpedic darning

  Hace 6 horas · Me gusta · 1
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  Kir Pat good

  Hace 4 horas · Me gusta
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  Kir Pat lag screw long

  Hace 4 horas · Me gusta
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  Michael Dujela Did you measure compartment pressures? Was fasciotomy performed? I am amazed at the low threshold of the foot for developing compartment syndrome. Despite a laceration being present, compartment syndrome can be a problem. Not everyone subscribes to fasciotomy for foot compartment syndrome anymore. 
  
  I approach something like this with external fixator to medial and lateral side of the foot to decompress allowing the dislocated segments to find their place. Admittedly more difficult with the calcaneus fracture to find an anchor proximally. Follow with definite fixation as you mentioned after some tissue rest.

  Hace 3 horas a través de móvil · Me gusta · 1
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  Kir Pat Michael Dujela,Do you use fasciotome on lat compartment ie pero only or medially ?It is neseccity instreument in lower limb surgery.Tourniquet also play role..but here it is in lower incision dehisence so more likely Hardware

  Hace 3 horas · Me gusta · 2
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  Michael Dujela Sorry Dr Patel, I didn't fully understand your question could you please rephrase for me? Thank you, apologies!

  Hace 3 horas a través de móvil · Me gusta
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  Alok Jain Rakesh Agrawal Michael Dujela Dr Kir Pat Is there an associated Overlooked Lisfranc injury...???
  Does the Calcaneo cuboid joint needs spanning plate or individual fixation is good enough....???

  Hace 2 horas a través de móvil · Me gusta
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  Michael Dujela Problem is the calcaneus fracture . I have spanned a navicular fracture before but normally just RX fix or lateral side. Yes agree probable lisfranc as well. Issue here I don think will be the musculoskeletal problems long term, but chronic pain/neuropathic pain almost assuredly.

  Hace 2 horas a través de móvil · Me gusta · 2
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  Alok Jain Would a preop CT have made a difference....?????

  Hace aproximadamente una hora a través de móvil · Me gusta
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  Indrajeet Deshmukh Nice.

  Hace 51 minutos a través de móvil · Me gusta
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  Rakesh Agarwal lag screw were removed at 3 months follow up when weight bearing was started. preop ct was done i havnt posted them. they really helped me to plan for calcaneum and cuboid fixation. lisfranc component was treated conservatively in post op immobilization

  Hace 49 minutos a través de móvil · Me gusta
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  Rakesh Agarwal calcaneal anterior process was collapsed with no joint capsule left. would it had been better to fuse rather than reconstruction of ant process?

  Hace 27 minutos a través de móvil · Me gusta · 1
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  Rakesh Agarwal compartment pressure wasnt measured, neither fasciotomy was performed. foot was kept on bohler braun splint and delayed medial wound closer was performed.