Tuesday, November 16, 2010

A Bummer of a Fracture

Back to the ER. Another guest appearance by me at an ER near you! This fracture is what happens to you if you are playing football in an asphalt parking lot wearing flip flops.

But first you need to be very heavy. Then you need to be intoxicated. Then you need to jump over a curb to catch a ball and land, with all your substantial weight, directly on the ball of your foot. That 'CRACK' and 'SNAP' you heard (before you collapsed on the ground in pain) were various bones and ligaments in your mid-foot being broken and ruptured.

This is a really bad fracture to get as, even with surgery, the foot is just never the same. We were able to 'reduce' this fracture by giving the patient propofol and putting him in a happy place for a few minutes while the Orthopedist and I pulled and pushed on his foot to get the dislocation 'un-dislocated', or, in doctor terms, 'reduced'. As soon as this is done a substantial amount of pain is relieved. This patient went home on crutches but will need surgery. The lisfranc fracture, don't get one.

* what i have attempted to show in the Xray above is that the metatarsal bones, the long bones in the upper portion of the Xray, are displaced to the left of the tarsal bones. There are also various small avulsion fractures that did not transfer well to this cell phone image.


  1. Why is it Eva Longoria never comes in with a bruised tootsie?? Its always these size 19 Sasquatches with toenail fungus and those creepy permanently bent toes...
    and thats just the women, Men's feet are even worse..
    Frank "Couldn't pay me enough to do your job" Drackman

  2. I did something similar and it led to 5 days in the hospital, 2 surgeries, and a year and a half on crutches. So I quit doing that. No, I didn't quit drinking heavily, I just quit participating in strenuous athletics.

  3. Can't you just chop his foot off and hand it to him in a baggie? I thought Obama said you guys do unnecessary amputations to make money.

  4. oh yeah, peggy, i told him he would have to have an amputation, but only for shits and giggles... he actually had insurance and i couldn't figure out any other way to take advantage of him like i usually do with all my patients. good point. he cried.

  5. Lisfranc's contribution to surgery (and what made him famous for that eponymous fracture-dislocation) was actually to amputate through that level. Three minutes, he could get it down to.

    I've had a bunch of ER docs missing Lisfrancs recently. If in doubt, scan it!