Toe fracture
- 1. Extern case conference THANYAPORN WISITPHORNANAN 5402064
- 2. case Patient profile ผู้ป่วยชายไทย อายุ 15 ปี Chief complaint ถูกหินเจียบาดเท้าซ้าย 7 ชม.ก่อนมาโรงพยาบาล
- 3. Present illness 7 ชม.ก่อนมาโรงพยาบาล ขณะทางาน ถูกหินเจียหล่นใส่เท้า บาดนิ้วชี้เท้าข้างซ้ายเป็นแผลลึก มีอาการชา ปวด ขยับนิ้วชี้เท้า ไม่ได้ ไม่มีบาดแผลบริเวณอื่น
- 4. Past History No underlying disease No current medication No drug allergy
- 5. Physical examination ABCD – OK GA – A Thai man , Alert , good consciousness , well co- operative V/S – Temp 36.7 HR 67 bpm BP 131/87 RR 16 /min HEENT – not pale conjunctivae , anicteric sclerae Lung – clear , equal breath sound both lungs Heart – normal s1 s2 , no murmur
- 6. Physical examination Laceration wound 0.5 x 2 cm. Deep to bone No active bleeding Capillary refill < 2 sec Limit ROM
- 7. Film Left foot AP
- 8. Film Left foot Oblique middle phalanx of 2nd toe of Left foot fracture
- 9. Impression Open Fracture middle phalanx of 2nd toe of Left foot R/O tear tendon
- 10. Toe Fracture
- 11. Anatomy
- 12. Management of Toe fracture First toe • role in weight bearing, balance, and pedal motion • require referral much more often than other toe fractures Lessor toe
- 13. Lessor toe fracture Treatment ‘Buddy taping’ 3 weeks Pain control Acute subungual hematoma decompression เจาะเล็บ release pressure
- 14. Lessor toe fracture referral is recommended for patients with open fractures, fracture-dislocations displaced intra-articular fractures, children with fractures involving the physis, except nondisplaced Salter-Harris type I and type II
- 15. Open Fracture
- 17. Management initial trauma survey and resuscitation IV antibiotics tetanus prophylaxis Dressing - remove gross debris , irrigation Immobilization Set OR for Aggressive debridement and irrigation
- 18. Antibiotic Treatment Gustilo Type I and II 1st generation cephalosporin for gram positive Gustilo Type III 1st generation cephalosporin for gram positive Aminoglycoside (such as gentamicin) for gram negative +- Penicillin for anaerobe in farm injuries or possible bowel contamination
- 19. Management in this patient NPO , 5%DN/2 1000 ml iv 80 ml/h Cefazolin 1 g iv q 6 h Tetanus toxoid 1 course Irrigation , dressing wound Immobilization MO 4 mg iv Set OR
- 20. Operation Finding • Open fracture middle phalanx of left 2nd toe • Partial tear EDL tendon of left 2nd toe
- 21. Operation Excision debridement with K-wire fixation with tendon repair