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PRESENTATION
11
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POLLS
5,967
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OUTCOMES
11
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VIDEOS
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EVIDENCE
28
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Comments
64
CASE DESCRIPTION
AGE 28 / Male
CC Right foot pain
HPI A healthy 28-year-old male presents to the trauma bay after being involved in an MVC. He is complaining of isolated right foot pain. He denies numbness and paresthesias to the right lower extremity. He states he is otherwise healthy and has no medical problems. A Closed Reduction is attempted in the emergency room prior to the CT scan but is unsuccessful due to the instability of the injury. Additional closed reduction attempts were not performed.
PMH PMH: morbid obesity
PE Focused physical examination of the right lower extremity reveals significant swelling of the foot without any open wounds. He is exquisitely tender to palpation over the plantar foot. Patient unable to flex ankle or wiggle toes secondary to pain. Sensation of the foot and toes remains intact. The foot is warm and well perfused.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/101882/3cc3960e-5329-4a3e-b395-9a9a371bc7fe_ap_injury.jpg https://upload.orthobullets.com/cases/101882/324b7ae5-d3f5-4c8a-bd3c-298da67e2f97_lateral_injury.jpg https://upload.orthobullets.com/cases/101882/11f6aa12-5cc5-436c-a05f-2358769f5882_sagittal_ct1.jpg https://upload.orthobullets.com/cases/101882/d90b0287-e0a9-41f5-9516-133942c6e1c9_sagittal_ct2.jpg https://upload.orthobullets.com/cases/101882/e6408d33-597d-48bd-ba85-8720a61bcfe3_sagittal_ct3.jpg https://upload.orthobullets.com/cases/101882/b24bbaa9-6bba-4e5a-b0b8-7c6bb8e8c2f1_sagittal_ct4.jpg https://upload.orthobullets.com/cases/101882/f80bca9a-24ac-460f-9b72-eb1196c2f0f4_sagittal_ct5.jpg https://upload.orthobullets.com/cases/101882/84b06b1f-e285-4566-8276-80553708a506_axial_ct1.jpg https://upload.orthobullets.com/cases/101882/e94b6ac4-870b-4eb0-9105-f8fe72d4772f_axial_ct2_.jpg https://upload.orthobullets.com/cases/101882/31feba84-68be-4035-94d8-a9cc09602690_axial_ct3.jpg https://upload.orthobullets.com/cases/101882/7db26ae2-e556-4152-b81d-28d71c9e44b0_axial_ct4.jpg
POLLS
OB Community
1) In addition to plain film radiographs, would you obtain any other imaging to guide management?
Other
2) Based on the injury Xrays shown, would you attempt Closed Reduction in the Emergency Room?
Other
3) How would you manage this patient?
Other
4) If you choose Operative management, what type of treatment would you choose?
Other
5) If you choose Reduction & Fixation, what technique would you do?
Other
6) If you choose ORIF Alone, would you temporize this patient, and how?
Other
7) If you choose ORIF Alone, which of the tarsometatarsal joints (TMTJ) would you fix?
Other
8) If you choose ORIF of the 1st + 2nd + 3rd TMTJ, would you include the Cuneiforms?
Other
9) If you choose ORIF of the 1st + 2nd + 3rd TMTJ without the Cuneiforms, what approach would you use ?
Other
10) If you choose ORIF of the 1st + 2nd + 3rd TMTJ without the Cuneiforms, what fixation type would you use?
Other
11) If you choose ORIF of the 1st + 2nd + 3rd TMTJ and obtained the construct below, when would you allow full weight-bearing post-operatively?
Other
12) If you choose ORIF of the 1st + 2nd + 3rd TMTJ and obtained the construct below, when would you plan on removing hardware?
Other
CASE OUTCOMES
PROCEDURE 1: Open reduction and internal fixation of right lisfranc fracture
POLL#
SURGEON CHOICE
1
In addition to plain film radiographs, would you obtain any other imaging to guide management?
Yes - CT scan (CT)
3
How would you manage this patient?
Operative
5
If you choose Operative management, what type of treatment would you choose?
Reduction & Fixation
6
If you choose Reduction & Fixation, what technique would you do?
Open reduction internal fixation (ORIF) only (includes plate, screws, wires, minimally invasive plate)
7
If you choose ORIF Alone, would you temporize this patient, and how?
No - I would fix acutely
8
If you choose ORIF Alone, which of the tarsometatarsal joints (TMTJ) would you fix?
1st + 2nd + 3rd
9
If you choose ORIF of the 1st + 2nd + 3rd TMTJ, would you include the Cuneiforms?
Yes - Medial-Middle Cuneiforms
10
If you choose ORIF of the 1st + 2nd + 3rd TMTJ without the Cuneiforms, what approach would you use ?
1 incision - Medial Alone
11
If you choose ORIF of the 1st + 2nd + 3rd TMTJ without the Cuneiforms, what fixation type would you use?
Plate(s) + Screw(s)
12
If you choose ORIF of the 1st + 2nd + 3rd TMTJ and obtained the construct below, when would you allow full weight-bearing post-operatively?
6-8 weeks
13
If you choose ORIF of the 1st + 2nd + 3rd TMTJ and obtained the construct below, when would you plan on removing hardware?
I would not plan on removing hardware
DOP: 1/1/2022
Intra-procedure P1
https://upload.orthobullets.com/cases/101882/42af2e93-eac0-4b8f-9950-a1d0c4ef5468_intraop_1.jpg https://upload.orthobullets.com/cases/101882/d28b01de-247e-4735-aec9-62fb24df9c8e_intraop_2.jpg https://upload.orthobullets.com/cases/101882/7a301aa2-63ae-47a7-97b7-957cef7c35c6_intraop_3.jpg https://upload.orthobullets.com/cases/101882/4a8b64d1-8d0b-464f-86b1-8feefe67babb_intraop_4.jpg https://upload.orthobullets.com/cases/101882/07f424c4-24d4-4628-8e72-558996b765a3_intraop_5.jpg
Post-procedure P1
https://upload.orthobullets.com/cases/101882/5a03ce4e-3138-48f5-8f8c-d4018f435729_post_op_1.jpg https://upload.orthobullets.com/cases/101882/3ec84350-9b0f-4994-b6aa-12a5590ebbdb_post_op_2.jpg https://upload.orthobullets.com/cases/101882/4bd55cc8-cc23-4b65-9c04-545d0f1855c6_post_op_3.jpg https://upload.orthobullets.com/cases/101882/d1eb4e3f-9d15-4eea-a096-21de87518c18_lisfranc3.jpg
Post-procedure P1
6 weeks Post-procedure P1
https://upload.orthobullets.com/cases/101882/51c35e9d-1583-47d3-b663-b33b06703a18_lisfranc1.jpg https://upload.orthobullets.com/cases/101882/dcdf729a-c8fa-483b-a96d-9eb201ab544c_lisfranc2.jpg
VIDEOS & PODCASTS (5)
EVIDENCE (28)
EXPERT COMMENTS