[SavageGlow]

A load of 21 tons fell on my leg at the plant.

The foot was subsequently amputated .


Not my story. Translated from Russian.

[Mr.NoCredit]

Yep. That’s a smooshed foot alright.

[Eternally Solo]

Looks like a massive toe with a HUGE toenail

[ride]

Imperial tonnes or metric tons?

[SavageGlow]

Originally Posted by ride ↗

Imperial tonnes or metric tons?

I don't know!

[kellyhound]

Alliance Community Hospital in Alliance, Ohio.
A 48-year-old male patient presented to the emergency department within an hour of sustaining a crush injury to his foot at work. He was alert and oriented with an overall pleasant demeanor despite the condition of his foot.

The patient related a history of a 47,000-pound metal object falling on his foot. He stated this remained on his foot for several minutes while awaiting the arrival of a forklift to remove the object.

The patient admitted to wearing steel toe boots when this occurred. He denied any other injuries and any loss of consciousness. The patient was also able to relate that the more proximal part of his foot was spared from the crush injury by the way the object was shaped and landed.

The patient’s past medical history was non-contributory. He denied any significant past medical history. He did admit to being a current everyday smoker and to smoking one pack of cigarettes a day for many years.

Despite the significant trauma sustained to his foot, his dorsalis pedis and posterior tibial pulses remained palpable at +2/4. His light touch sensation was intact to his plantar forefoot. Compartment syndrome did not appear to be a complication in this scenario because of the open nature of his injury and the sparing of his midfoot and ankle from injury.

Upon presentation to the emergency department, blood loss was minimal given the extent of the injury. There was no pulsatile bleeding.

As visible in the photos, his skin had already begun to demarcate via ecchymosis and early necrosis.

The patient sustained partial amputations of the second, third and fourth digits with multiple comminuted open fractures. We would classify this as Vora and Myerson Type II injury.

Prophylactic parenteral antibiotic use consisting of cefazolin and gentamicin began in the emergency department. Additionally, the patient received tetanus prophylaxis.

After discussing all possible treatment options with the patient, we agreed to proceed with a transmetatarsal amputation. The patient presented to the emergency department having had nothing by mouth (NPO) since dinner the evening before, which allowed him to go to surgery within several hours of the injury.

We thoroughly debrided the wound and flushed it intraoperatively with copious amounts of normal sterile saline. The lead surgeon felt there was enough healthy skin to perform a primary closure. We left a Penrose drain in place to allow drainage over the next several days.

The patient stayed overnight in the hospital for observation and was discharged home the next day.

Subsequent follow-up in the office, the patient demonstrated multiple fracture blisters to the dorsum of his foot. The incision site remained intact with some necrotic changes to the dorsal and lateral aspect.

The fracture blisters had drainage and cleansing with betadine. We will continue to monitor the patient closely over the next several weeks to months until complete resolution of his wounds occurs.

[SavageGlow]

Awesome, thanks!

[Eternally Solo]

Contribution to the thread by Eternally Solo:

Full%20foot%20reconstruction%20by%20Chimeric%20Mic rovascular%20flap.mp4