Would like to submit the following case for the Listserv
input/review/opinion.
32 yo highly active(surf, ski, snowboards, black belt in karate, rock
climbing, mountain bike) large (6’3, 255#) educated (MBA) male, 3 days post
MVA(hit by car on bike) resulting in Lt midshaft tib fib fracture(closed), Lt
malleolar fracture with ankle/subtalar dislocation, open,
contaminated,crushing injury to midfoot. Currently fractures managed in
seperate Ext Fixators. Forefoot is cold, seeping serosanguinous fluid and
likely will require amputation. Rt LE has tib/fib fx’s currently in posterior
splint(ORIF pending). No head trauma or UE involvements. 6mos s/p ACL
reconstruciton on LT knee.
Concern is with Lt LE. Will most likely require amputation within 48 hours.
Due to amount of soft tissue damage to midfoot and plantar surface, Symes
level amputation would probably heal but require plastic surgical
interventions. Would probably result in prosthetically marginal Symes.
Mother happens to be ER nurse.
What are recommendations? Try for Symes level first, keeping Ex-Fix to allow
tib-fib union and pursue plastic surgical options? or outright go to BK with
Ertl?
Will post summary of replies, (eventually)
Ralph W Nobbe CPO
