Achilles tendon rupture in 54 yo female. Patient fell at home going up the stairs. Previous history of Achilles rupture during college. Patient is asleep for surgery – we are demonstrating a positive Thompson’s test on the right side where the calf is squeezed, and the toes do not plantarflex (point). Whereas on the the left side when the calf is squeezed the toes do point towards the floor.
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This patient had an Achilles tendon rupture in 2015 while on vacation in the Bahamas. A mostly sensate IDDM ... 4 surgeries later, and a finally healed Achilles tendon, unfortunately however left her with chronic osteomyelitis of her calcaneus. She was referred to us in 2019. At that point she had failed 3+ yrs of wound care, immobilization, antibiotics (both oral and IV), and was living with a draining sinus tract at her medial heel. I suggested to the patient further surgery. She had multiple MRI's, and a CT scan demonstrating the chronic OM. She declined surgery however, and even cancelled after she scheduled with us twice, due to admitted PTSD from the ordeal spanning the course of 6 years. I suggested to her (not in order) we debride the bone through the sinus tract -take cultures, irrigate, excise the wound, fill the void with a non-phosphate antibiotic impregnated bone filler (Cerament), close with heavy suture, and hope for the best. After 2 years of deliberation under our care she finally agreed, and that's what we did. A culture in our office taken from active purulence in 2019 grew Enterobacter Cloacae, the repeat culture in the OR in July of 2021 also grew Enterobacter Cloacae. We used Gent/Vanc for the Cerament, although Cerament does not recommend using Gent. During surgery as soon as we started to debride the bone with a small curette, a long, purulent strand of fiberwire shot out from the intramedullary canal. This answered the question of the non-healing tract.
She is now 2 months out from surgery, and doing great. Wound free for the first time since 2015.
Chronic gout, and years of wear n tear from hauling the mail, on foot, in this 60 yo male!
I have not seen a lot of tophaceous gout at the TN, but this fellar had a nice collection of cottage cheese at the dorsum of the joint intra-op.. Pain at dorsal TN, and with STJ range of motion. Particularly, middle facet degeneration. ….Just a nice simple Gastroc recession, TN tidy up, and ST arthrodesis.
He was back carrying mail in 12 weeks....
Welcome - Kelly Peasley, FNP!
She is a board certified Family Nurse Practitioner. She joined our practice at Hancock Ortho in May. She sees patients in clinic on Tuesdays, and Thursdays.
She has practice experience in primary care, urgent care, and long term care. Prior to becoming an NP, she was an RN in surgery for over 10 years at both Level 1 trauma centers, and community hospitals. She’s happy to return to her surgery roots, and ditch the ophthalmoscope. She is in surgery with Dr. Adams and Co. Mon, Wed, and Friday. Hancock Ortho is lucky to have Kelly’s experience, and knowledge. When she’s not holding retractors and seeing patients, you can find her driving and cheering for her 3 daughters on and off the ball fields, and courts.
MSN-Family Nurse Practitioner, University of Southern Indiana, 2018
This 40 yo female presented to ED after falling over baby gate inebriated. Pt was splinted, then subluxed in our office once splint was removed to eval skin. We performed hematoma block, closed reduced, and splinted again, then transferred her back to ED for admission as hospitalist would not accept direct admit. Pt has paroxysmal A Fib and needed d/c of eliquis prior to surgery, and was not good candidate to go home. We performed ORIF inpatient, prone, then finished supine, 5 days after fracture. Pt has done excellent.
On the CT’s if you look close, her medial mall was mildly comminuted which is why we chose to use plate for fixation, …and a secondary independent lag screw to capture the tiny avulsed piece of anterior colliculus that was loose. As usual the fibula hardware very much precludes good visualization of the post mall reduction….Our rec is to dissect PM, reduce fibula (temp fixation only), go back and fixate PM to visualize good reduction, then definitively fixate fib to allow good visualization….That sequence, or a dry scope through posterior capsule help ensure good reduction…...
This 50 yo male was referred from another facility a couple hours away. 30 years ago he sustained shotgun blast to the leg. He went to the Detroit trauma center, and with free flaps, external fixation (6+ months), extensive inpatient care, and an ankle fusion he was able to salvage his leg, and ankle with a little stiffness, and jewelry to show off.
He came to us with painful STJ motion, and a lack there of.
Really straight forward case with the exception of going medial to stay out of his flaps laterally.
This worked well thankfully, and thus far his skin is healing beautifully.
Assistant Surgeon: Dr. William McGlone, DPM, PGY-IV
Extremity Medical Hardware, and graft used. I am a paid consultant....