Managing Complications After a Crush Injury to the Foot

Crush fracture of the foot?

Hello Doctor, there is a 36-year-old man who suffered a crush injury to his right foot in December, resulting in a comminuted fracture.
He underwent surgery and had four pins placed near his toes, along with an external fixator on the right side.
He was scheduled to have all the pins removed, but on January 28, while using crutches, he accidentally fell and landed heavily on his right foot.
It was very painful at the moment, and he couldn't sleep all night.
The pain is slightly worse than usual, and there is bleeding near the pin site close to the heel of the external fixator.
I would like to know if this could worsen his condition and what serious consequences or complications might arise.
After the pins are removed, are there any special precautions he should take? Will he be able to walk, run, jump, hike, and engage in other activities like before? Also, when is it safe for him to drive or go hiking again? Thank you for your response, Doctor.

Miss Huang, 20~29 year old female. Ask Date: 2016/01/29

Dr. Shi Guozheng reply Orthopedics

If a fracture does not require surgical intervention, it is still important to protect the area for a period of time after the removal of any hardware, such as pins or screws, to ensure complete healing.
The duration before resuming physical activity depends on the location of the fracture and the number of bones involved.
You will need to consult your attending physician for specific guidance.
Additionally, the severity of the fracture and whether it is comminuted also affects the recovery period.

Reply Date: 2016/01/29

More Info

After experiencing a crush injury to the foot, particularly one that results in a comminuted fracture, it is crucial to manage the complications that may arise during the healing process. In the case of the 36-year-old man who suffered a crush injury and subsequently fell while using crutches, there are several important considerations to address.

Firstly, the immediate concern after the fall is the increased pain and the presence of bleeding near the external fixation site. This could indicate a few potential issues, such as irritation or damage to the surrounding tissues, or even a possible displacement of the fracture. It is essential to seek medical attention promptly, as the increased pain and bleeding could signify complications that may require further intervention. An X-ray or other imaging studies may be necessary to assess the integrity of the fracture and the position of the hardware.

In terms of potential complications, the patient may experience delayed healing, non-union (where the bone does not heal properly), or malunion (where the bone heals in an incorrect position). These complications can lead to chronic pain, functional limitations, and may require additional surgical procedures to correct. The presence of external fixation devices can also increase the risk of infection, particularly if there is any open wound or drainage.

Regarding the removal of the hardware, once the pins and external fixators are removed, the patient should follow a rehabilitation program that includes physical therapy. This is crucial for regaining strength, flexibility, and function in the foot and ankle. The timeline for returning to activities such as running, jumping, hiking, or driving can vary significantly based on the individual’s healing process, the extent of the injury, and the recommendations of the orthopedic surgeon. Generally, it may take several weeks to months before the patient can safely resume high-impact activities.

For driving, it is essential to ensure that the patient has regained sufficient strength and range of motion in the foot and ankle. The ability to operate the vehicle safely is paramount, and this may require a consultation with a healthcare provider to assess readiness.

In summary, after a crush injury and subsequent fall, it is vital to monitor for complications such as increased pain, bleeding, and potential hardware issues. Regular follow-up with an orthopedic specialist is necessary to evaluate the healing process and to develop a rehabilitation plan. The patient should be cautious about resuming activities and should prioritize gradual progression under the guidance of healthcare professionals. With appropriate care and rehabilitation, many individuals can return to their previous levels of activity, including sports and driving, but this should be approached carefully to avoid re-injury.

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