True Stories From Podiatric Residency

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
ANkle fusion today for a terrible pilon s/p ORIF, wound dehissence, OM of the fibula, removal of fibula, abx cement placement and ex-fix, removal of abx, (-) cultures -- then finally ankle fusion.

Since he had crappy skin laterally we did a posterior approach w/ removal of the achilles w/ osteotomy of calc (reattaches as bone to bone).

Posterior tibial locking plate w/ locking screws in talus and cortical screws in tibia. The defect of bone was approximately the distal 1/4 of the tibia so bone was harvested from the femur thru the synthes reaming/bone graft system. Then the posterior mal was in the way so it was removed to achieve better plate apposition w/ the bone. The achilles was lengthened to reattach it w/ screws thru the bony fragment. Great case!
Members don't see this ad.
 
on foot and ankle ortho. now.....in the past week, have done 4 ankle fusions, 2 ankle ORIF's, 2 lateral ankle stabs., 2 cavus reconstructions, 2 flatfoot reconstructions, and a 5th met non-union!

Last time on his service, I did 4 TAR (Salto-Tolaris).....still have 18 days left!
 
Foot Doc said:
on foot and ankle ortho. now.....in the past week, have done 4 ankle fusions, 2 ankle ORIF's, 2 lateral ankle stabs., 2 cavus reconstructions, 2 flatfoot reconstructions, and a 5th met non-union!

Last time on his service, I did 4 TAR (Salto-Tolaris).....still have 18 days left!
Click to expand...
Wow... that's more fusions and TARS in a week than a lotta ppl will do in their whole residency :thumbup:

Seems like Ohio/PA/Louisville area is becoming one of the meccas for TARs (along with west coast)...
Grant's program and the OSU fellowship had a few nice posters on Salto-Tolaris and InBone at the ACFAS meeting. I still only know what I read, but it's always interesting seeing the results or listening to the ongoing fusion/implant debate.
 
Members don't see this ad :)
Feli said:
Wow... that's more fusions and TARS in a week than a lotta ppl will do in their whole residency :thumbup:

Seems like Ohio/PA/Louisville area is becoming one of the meccas for TARs (along with west coast)...
Grant's program and the OSU fellowship had a few nice posters on Salto-Tolaris and InBone at the ACFAS meeting. I still only know what I read, but it's always interesting seeing the results or listening to the ongoing fusion/implant debate.
Click to expand...


yeah we're pretty busy......I think TAR's are beneficial, but patient selection is key!
 
I&D of septic hip today thru smith-peterson incision (he worked w/ Sir Robert Jones).

We extended this incision to the retroperitoneal incision to drain the psoas abscess that communicated w/ the septic hip.

On x-ray he had scalloping erosions of the acetabulum and MRI showed a 10x17cm mass.

Good anatomy today! I touched a kidney, the spine, and the inferior vena cava!
 
krabmas said:
I&D of septic hip today thru smith-peterson incision (he worked w/ Sir Robert Jones).

We extended this incision to the retroperitoneal incision to drain the psoas abscess that communicated w/ the septic hip.

On x-ray he had scalloping erosions of the acetabulum and MRI showed a 10x17cm mass.

Good anatomy today! I touched a kidney, the spine, and the inferior vena cava!
Click to expand...

Strong work!
 
krabmas said:
I&D of septic hip today thru smith-peterson incision (he worked w/ Sir Robert Jones).

We extended this incision to the retroperitoneal incision to drain the psoas abscess that communicated w/ the septic hip.

On x-ray he had scalloping erosions of the acetabulum and MRI showed a 10x17cm mass.

Good anatomy today! I touched a kidney, the spine, and the inferior vena cava!
Click to expand...


you always have the best stories and, while i'm only beginning school this fall, you've already made me want to do residency at INOVA :D
 
did 7 cases today.

Watched an attending (F&A ortho) remove the forefoot off the midfoot. we made the incision skin to bone circumfrencially around the foot then he grabbed the forefoot and twisted and disarticulated the lis franc joint. Then we irregated and closed.

The other cases weren't as exciting.
 
Last edited:
did 10 cases with a F&A Ortho here this week so far......3 ankle scopes, 1 ankle fusion, 1 STJ fusion, 1 ganglion excision, 2 knee scopes, Humerus ORIF, and a flatfoot recon.
 
ohhyourgod said:
you always have the best stories and, while i'm only beginning school this fall, you've already made me want to do residency at INOVA :D
Click to expand...

I don't know about that, Krabmas' cases are great but I think Jonwill has had some pretty strong cases also ;) and foot doc is def up-and-coming . These posts have become less frequent. I guess PGY-2 is keepng you guys pretty busy.
 
did he make it?
 
oh my god, is that sort of traumatic case pretty common to come by every once in a while during residency training?
 
ThetaChiNAU1856 said:
oh my god, is that sort of traumatic case pretty common to come by every once in a while during residency training?
Click to expand...
You won't see that kind of case most places. Only if you're at a program based at a level 1 (or maybe 2) center and you are rotating with the ER, the trauma service, or ortho trauma.

http://www.facs.org/trauma/verified.html (some states don't designate trauma centers and some hospitals that do a lot of trauma don't apply for it, but this is a pretty complete list)
 
Last edited:
Members don't see this ad :)
krabby, like i said, amazinnnnnnnng stories/pics
 
For those who (like myself) aren't technologically savvy, here is
the image of a stump grinder:

Stump_Grinder.jpg
 
I'm going to go ahead and classify those as Gustillo-Anderson IIIC's, just off the top of my head.
 
The box splint being used in that last picture almost seems unnecessary at this point :eek:

Sorry if that's not the medical term for that yellow splinting device...it's what we call them on the mountain, but all we ever need them for is stabilization of a skier's knee post-ACL tear :laugh: Never to keep the lower limb from falling off!
 
dtrack22 said:
The box splint being used in that last picture almost seems unnecessary at this point :eek:

Sorry if that's not the medical term for that yellow splinting device...it's what we call them on the mountain, but all we ever need them for is stabilization of a skier's knee post-ACL tear :laugh: Never to keep the lower limb from falling off!
Click to expand...

I consider them death to limb devices. If you use them for traction the cord across the foot all but disvacularizes it.

The trauma team thinks they are helping somehow and I'm sure they are, but all we do is remove the device, move the limb, get more x-rays, then splint or place traction pins.

Removing the yellow splint just means one more step.
I'm sure I am missing something, like comfort to the patient.
 
densmore22 said:
I'm going to go ahead and classify those as Gustillo-Anderson IIIC's, just off the top of my head.
Click to expand...

You might have been joking but...

The guy run over by the car presented w/out DP,PT or popliteal by doppler B/L as well as w/out radial or ulnar RUE where he had an open both bone fracture. For shortness we will just say that he had multiple fractures in both legs.

The reason that he presented w/out pulses is not necessarily due to vascular injury. He was hypotensive and swollen which made detecting pulses by palpation or doppler difficult.

The R leg was an immediate AKA due to location of fractures and function not due to vascular supply. The patient had a palpable popliteal by the time he was on the OR table. Actually, by the time vascular did angiograms all extremities were well supplied.

So I guess I would classify his R leg as IIB.

He has since gone on to a R hip disarticulation which I revised for the 2nd time today - debride, debride, debride.

The guy that got caught in the stump grinder is a different story - IIIC for RLE, LUE - definitly.
 
krabmas said:
Removing the yellow splint just means one more step.
I'm sure I am missing something, like comfort to the patient.
Click to expand...

I have a feeling this patient didn't mind either way. Our box splints have a couple inches of foam padding lining them which lets us tighten them down quite a bit, never for traction purposes (thats what a KTD is for), and they are definately used for comfort. If you've ever had to ride down a mountain behind a patrol toboggan then you'd appreciate a good splint job to keep your new tib/fib fracture from bouncing around.

Great stuff krabmas :thumbup:
 
dtrack22 said:
I have a feeling this patient didn't mind either way. Our box splints have a couple inches of foam padding lining them which lets us tighten them down quite a bit, never for traction purposes (thats what a KTD is for), and they are definately used for comfort. If you've ever had to ride down a mountain behind a patrol toboggan then you'd appreciate a good splint job to keep your new tib/fib fracture from bouncing around.

Great stuff krabmas :thumbup:
Click to expand...

see, I knew I was missing something. Hopefully I will never have to test this out for my self.
 
I know I've been slacking on this thread but we've got to keep it interesting. I got called in at 3AM for an MVA. The lady sustained a hawkins II talar neck fracture on the right and a bimalleolar ankle fracture on the left. We're doing the talus today and will most likely do the ankle on Friday.
 
Last edited:
jonwill said:
I know I've been slacking on this thread but we've got to keep it interesting. I got called in at 3AM for an MVA. The lady sustained a hawkins II talar neck fracture on the right and a bimalleolar ankle fracture on the left. We're doing the talus today and will most likely do the ankle on Friday.
Click to expand...

Did you close reduce the STJ?
 
krabmas said:
Did you close reduce the STJ?
Click to expand...

No, the talar body was plantarflexed on the talar neck and was basically stuck under it. We did it yesterday. I did the ankle and my senior stole the talar neck (soon we'll be seniors)! We put an ex fix on to distract it out so we could fixate it.
 
How about you residents revive this thread! You guys have some pretty interesting stories, very fun to read. :)
 
Darklord said:
How about you residents revive this thread! You guys have some pretty interesting stories, very fun to read. :)
Click to expand...

excision of osteochondromatosis from 1st MPJ
flexor tenotomy - repair of hammertoe
laser excision of warts - apparently unser loupe mag the laser rxn w/ warts looks like a nuclear rxn.

rotational random pedicled skin flap - died 2 days later, but learned how to apply bolster dressing for skin graft or integra, VAC could not be used due to close proximity to rot. flap.

cubital tunnel release for ulnar nerve entrapment
DIPJ fusion in finger
repair of thumb lac - nerve, tendon, volar plate, collateral ligament

plantar fasciotomy x2
brostrum
Austin

nothing extremely exiting lately.
 
did a Triple and two ankle ORIF's my first day of Ortho Trauma last month...haven't added up the totals yet, but it was a BUSY april!
 
partial hallux amp last night - closure tomorrow
Lawnmower partially amped hallux today - finished and closed in OR.

Saving lives one toe at a time! (This will be on my business card one day, maybe I should copywrite it?)
 
A young lady was doing crack with a bunch of other people in a moving vehicle. The others decided it would be a great idea to throw her out of the vehicle which for me meant an I&D of an open achilles tendon laceration/rupture at 1AM!
 
jonwill said:
If I get one more GSW to the foot, I'm going to SCREAM!!!:p:p:p
Click to expand...

Let me guess, the entry point was the bottom of his foot while he was sitting on the stoop minding his own business when the stray bullet crawelled under his foot?

Or was he walking to/home from church? :laugh:

(sarcasm)
 
austin and brostrum yesterday.

Wrote rough draft of technique tip.

printed lots of articles.

writing proposal today.

research, research, research.....
 
krabmas said:
austin and brostrum yesterday.

Wrote rough draft of technique tip.

printed lots of articles.

writing proposal today.

research, research, research.....
Click to expand...

Nice,very nice. What are you researching on?
 
smartman716 said:
Nice,very nice. What are you researching on?
Click to expand...

lots of things, to be specific.

Lapidus, weil and 3nd PIPJ arthrodesis today.

Research - 2 case studies, retrospective review of pilons, something with hyperspectral imaging. maybe some other things as well.
 
I did a calcaneal fracture Wednesday night and then B/L calcaneal fractures this morning. It is going to be a crazy summer!
 
I know I'm not a resident yet (a few more weeks lol) but this was a cool case I scrubbed in last month :

59 y/o male with lateral ankle pain and history of recurrent inversion sprains. Approximately 6 months prior to the surgery date, he heared a "POP" from his ankle as he was playing tennis (He is a big tennis fanatic and plays during the summer) - MRI revealed a Peroneaus brevis rupture approximately 2 cm proximal to its insertion on the fifth metatarsal base. Patient also had a cavovarus foot-type as his Relaxed Calcaneal Stance Phase position was also in varus.

In the OR, the surgeon debrided the diseased tendon, used the FHL to augment the Peroneaus Brevis, re-inforced the ATFL with the pants-over-vest suturing technique, and performed a calcaneal slide osteotomy to get the heel out of varus. I thought the calcaneal osteotomy was very interesting as it addressed the mechanical deficit in the patient which made him susceptible to recurrent inversion sprains throughout his life. Very cool case
 
During residency, went to er for a foot infection. er staff had wrapped this ladies foot with a plastic bag and said I would have a surprise when I opened it. Opened it and was definitely surprised. Had more maggots fall out of that heel ulcer that I ever thought could have come out.

Then in private practice, slipped a remoted controlled fart machine up under the or table before the case started. Hid the remote in scrub top. Hit that thing like five times during the case and then turned to scrub tech and blamed it on her. Then snuck it into general surgeon's room and sat outside the door and kept hitting it. So much for professionalism.
 
Not a podiatry resident, but please tell me what you guys are doing to get admitting privledges!!!! I think it's crazy that we admit people to the medicine service for podiatric surgery, especially when no medical clearance is needed!!!! I thnink you guys are the best specialists to work with, but I'm wondering if you have a covert mission to "dump" on medicine like the other specialities (I hope I'm wrong on this one:))
 
allopurinol said:
Not a podiatry resident, but please tell me what you guys are doing to get admitting privledges!!!! I think it's crazy that we admit people to the medicine service for podiatric surgery, especially when no medical clearance is needed!!!! I thnink you guys are the best specialists to work with, but I'm wondering if you have a covert mission to "dump" on medicine like the other specialities (I hope I'm wrong on this one:))
Click to expand...

At the hospital I am a resident at we have no problem admitting to podiatry.

I think this is based on hospital policy and comfort level of the attending.
 
jonwill said:
I took Part III board exam today. Man, that was so much fun!
Click to expand...
I thought it was cool you could go back since all the Qs were in sets. Some of the pics looked like they were copies from a 1mp camera, though.

I think it went real well... some hard anesth and pharm questions, but should get good news in early or mid July.
 
You must log in or register to reply here.
Next unread thread

Similar threads

diabeticfootdr
Podiatric Sports Medicine
Replies
43
Views
2K
florida.podiatry
F
HalluxSlicer
Opinion; Expanding Podiatric Residency for MD/DOs
Replies
34
Views
1K
air bud
air bud
P
Nice Stories
Replies
39
Views
2K
Sweatshirt
Sweatshirt
T
Integration of Podiatric Services into every US Hospital
Replies
22
Views
2K
Retrograde_Nail
Retrograde_Nail
HalluxSlicer
ABPM CAQ in Podiatric Surgery
Replies
34
Views
2K
icebreaker32
icebreaker32
Top