Managing Traumatic Foot Wounds From Foreign Objects

Start Page:
Author(s): 
Vincenzo Palmieri, DPM, and Steven Geary, DPM

   Dr. Geary is a podiatry attending affiliated with the Captain James A. Lovell Federal Health Care Center in North Chicago, IL.

References

1. Singer AJ, Hollander JE, Quinn JV. Evaluation and management of traumatic lacerations. N Engl J Med. 1997;337(16):1142-8.

2. National Center for Health Statistics. Emergency department visits. Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/nchs/fastats/ervisits.htm. Updated May 30, 2013. Accessed February 12th, 2014.

3. DeCoster TA, Miller RA. Management of traumatic foot wounds. J Am Acad Orthop Surg. 1994;2(4):226-230.

4. Owens BD, Wenke JC. Early wound irrigation improves the ability to remove bacteria. J Bone Joint Surg Am. 2007;89(8):1723-6.

5. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453-8.

image description image description


dinovisjpsays: April 7, 2014 at 12:15 pm

A recent E.D. case of a dorsal penetrating wound with a previously used curved filleting knife through a dirt work boot of a kitchen worker comes to mind. The knife missed penetrating through the plantar skin by simply running out of kinetic energy. The patient pulled the knife out immediately. No fractures, no metal noted on X-ray.

In a review of this interesting article, several questions come to mind:

1) Were deep wound cultures taken intra-operatively especially in light of discontinuation of IV antibiotics after initial dosing?

2) Was acute compartment syndrome and release a consideration in light of pain severity and significant edema?

3) Was the tourniquet released prior to closure to assess for active bleeding and was deep soft tissue muscle appearance noted in the operative report?

Clinical Interest Note: I now use non-latex fenestrated penrose drains when needed due to a case of significant postoperative pain and swelling (with negative intra-op and repeat cultures from imbedded foreign body puncture) resulting in an extended stay (to await repeat culture results). Prior history of latex allergy was negative. Patient felt significant relief several hours after pulling the drain.

Thank you.

Jim DiNovis DPM

Reply to this comment »

Post new comment

  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

More information about formatting options

Image CAPTCHA
Enter the characters shown in the image.