Y SEGUIMOS AGUANTANDO! Cuántos años más?

AN UNUSUAL FOOT AND ANKLE INJURY IN A BASKETBALL PLAYER

30 YEAR OLD MALE PRESENTED TO THE ER AFTER A TRAUMATIC INJURY SUSTAINED WHILE PLAYING BASKETBALL. Plain films revealed a subtalar dislocation the right foot. What course of action will you follow?

Did you say you were riding a motorbike on a public roads with cars and you were drunk?

A 56 year old male was hit by a car that crashed against his motorcycle. He was intoxicated with alcohol. He sustained serious injuries including an open dislocation of the right ankle and a degloving injury of the right foot. A compartment syndrome of the foot was also diagnosed.
The patient was taken to the OR on an emergency basis for fasciotomy, debridement, repair of muscle and ligament injuries, and skin grafting to the right foot.

Follow up on open subtalar fixation

Cultures of the contminated bone with debri before washings were negative. She has progressed very well and is still working with the external fixation device.

Open subtalar joint subluxation

47 year old woman sustained an auto accident and presented to the emergency room with an open subtalar joint subluxation of the right leg. It was noted on exam that the right leg, that the talus had completely subluxed from the ankle, talonavicular, and subtalar joint. It was also noted that pieces of rug and other debri were imbeded in the bone.

The patient was taken to the OR immediately and surgically treated with open reduction with external fixation of the right leg. The bone was curettaged and the ankle joint was pulse lavaged with copious amounts of normal saline and antibiotic solution. Cultures had been taken prior to the above.

How do you think that this patient did?

Massive lymphedema in a diabetic man

A 67 year old man presents with chronic case of bilateral lymphedema. The patient has several serious medical problems including CHF, diabetes mellitus, a Whipple procedure for carcinoma of the pancreas 14 years ago, and morbid obesity. He also had an amputation of second and third digits of the left foot. I am surprised that he gives not history of previous ulcerations with the degree of lymphedema that he presents with. On exam he has decreased sensation in the feet. A diagnosis of severe onychomycosis and xerosis was made. The patient was instrcuted that he should not ambulate wihtout shoes. I do not think that his feet would fit into a standard pair of diabetic shoes. What else can we do for this man?