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post #1 of 18 Old 09-14-2019, 04:43 PM Thread Starter
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Opinions Please

I was not sure where to place this but as it could effect future riding I am placing the thread here.


Labor Day (Sept.2) my child had a UTV flip over on top of him (his leg). He landed with the left leg arch down and outside edge up. He was wearing steel toe boots. The cap of the boot caught the balance point of the UTV. There was no distortion of the steel cap.


He was taken immediately to the E.R. there they kept us waiting (no blood) and when finally brought back promptly removed the boot. Swelling was instantaneous. They brought in a portable XRay instead of taking him to radiology and did three views of the ankle and three of the metatarsals (two top and one slightly to the side of the outer edge).



Their opinion: No breaks seen. No soft tissue damage. Swelling is from a hematoma. Keep in mind the foot (up into the ankle) was twice the normal size and swelling was all over.


Their treatment plan: Ice and elevate. Use compression for the first couple of days. They offered a boot OR crutches but wanted him placing weight on the foot the next day. Saw no reason for him to stay home. I was repeatedly told how important ice was over the hours we were there but even when asked we were not brought an ice pack. They wrote a prescription for percocet "to get him through the pain" (their words not mine) and said he could have tylenol pm if needed. Note there was no offer for pain relief while there. I did fill RX and he was given one to help him sleep through the night. Didn't happen as pain was still too great. He got a second in the morning due to level of pain. Any time he stood (bathroom) he would just about pass out and had to be in my room as that was the shortest distance to restroom. Tuesday afternoon I gave him tylenol rapid release and that night tried the tylenol pm. He slept some but I think it was exhaustion more than anything else. Tylenol did little to nothing for the pain.



Reality: Tuesday - Nausea to the point of vomiting once standing, increased swelling even with compression and ice. We couldn't get the boot on his foot. Two reasons - pain from trying to close the velcro on the liner which could not be brought close enough to close the liner and added pressure of trying to close the liner much less the velcro on the boot. Foot was snow white. He stayed home Tuesday. RICE



Wednesday was more of the same. He did take one percocet that morning then again switched to tylenol RR. He stayed home both days with continued RICE. With no change - foot still white, swelling still twice size of normal and nausea/pain levels high, I took him to the Urgent Care when I got home from work. They took more xrays and utilized different views.



Their opinion: No breaks but with weight any unseen fracturing would expand, watch for compartmentalization, there was some degree of soft tissue damage yet to be determined because of swelling. Expect bruising - in their light you could see a bluish cast to the foot.



Their treatment plan: Continue RICE except alternate heat, excuse given through the 9th of September (including elevation in the classroom when he returned) and was instructed to use boot AND crutches with him making attempt to wear boot and get around for short periods over the weekend so that getting around school wouldn't be an issue. They RX'd 800mg Ibuprofen. We switched to that and I neutralized the remaining percocet.


NOTE. I had called the orthopedic on Tuesday following the accident and they would not see him until the swelling went down and/or a week had passed. He had an appointment scheduled for Tuesday the 10th.



From Thursday following the U.C. visit to Monday morning we did as instructed. Swelling reduced but did not resolve entirely. Bruising began to appear in earnest and was mainly in the toes. There was some initial on the top of the foot. Still complaints of pain but could stand for short periods - Foot would throb and have stabbing pain. He went to school on Monday was told he couldn't elevate in class. Medicated before leaving and next dose due at 3pm. He called at lunch to be picked up. I picked him up by 1pm and brought him home. He had boot, compression bandage and crutches. Sent him to school Tuesday same med schedule with repeated instruction to be allowed to elevate. He called again at lunch. I picked him up at 2 for the ortho appointment. Nurse kept him in her office to elevate so he still ended up missing classes.



Ortho Appt: They had him remove boot, remove compression and put full weight without crutches which had him vomiting from pain. Took more xrays. Full weight on foot. He's sheet white at this point with tears running down his face. Dr comes in and extols the virtue of steel toe boots. Says he'd still be piecing bones together had he not had them on. OK I get that. That's why he wears them. Then I get chewed on for not following ER instructions and having him walk on foot the next day. (PLEASE someone explain the rational behind that one). He was to leave compression bandage off because I (according to Dr) have no clue how to apply one and that is what is keeping the swelling from leaving NOT him being up and on it and not allowed to elevate. (With it slow reduction/without increased swelling - my observations over the week). I was told U/C. is over cautious and over medicates. HELLO - who RX'd the percocet (60) NOT the UC. According to Ortho he shouldn't need anything for pain and they could not excuse his absence Monday afternoon but would give him a note for the appointment Tuesday as long as I did not pick him up before necessary. He was to go ahead and use the boot but wean himself off crutches by just letting them take some of the weight. They wanted no crutch by the end of the week. And he's cleared to ride just not with a stirrup on that side.



Pain has not abated. Swelling continues. New bruising has appeared and he was not able to stop using the crutches though he is putting weight as they want because he was told he would not be allowed to weld in class in the boot. Ortho wants PT three times a week for three weeks starting this coming week. He will reevaluate two weeks in.



I'm going to post this and switch to phone to see if I can load pictures.
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post #2 of 18 Old 09-14-2019, 04:45 PM Thread Starter
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post #3 of 18 Old 09-14-2019, 04:50 PM Thread Starter
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Ok it is not letting me do this the way I want. Xrays are from ER. Photo is from UC (6pm)Wednesday 4th.
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post #4 of 18 Old 09-14-2019, 04:52 PM Thread Starter
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From today.
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post #5 of 18 Old 09-14-2019, 09:01 PM
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I"m, not a nurse or doctor, and can't tell much from the x-rays, but I am singularly unimpressed with the care you are recieving.


First of all, Pain relief medicine is for EXACTLY this sort of situation; an injury that will heal, but you need to REST in order for it to heal, so you need to take enough actual pain relief medicine to be able to rest. Thus, only a real pain reliever will do that, and that means codeine. Sorry, but that is the real blessing of this miracle drug; relief from agony. Don't be scared to accept this blessing. Don't try to 'get by' on less. For the first day or two, use it to allow the mind and body to rest. THEN you go to the tylenol pm and ibuprofen.


Secondly, pain to the degree of wanting to vomit (and since he hasn't taken any codeine, he's not feeling nauseous due to that), is trying to tell yo something; DON"T put weight on me!!!!




I think you should request an MRI. The tendons could have been seperated from the attachement points. Such a high degree of pain seems to indicate a soft tissue injury.


Remember, the squeeky wheel gets the grease, apparently more so in your situation.
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post #6 of 18 Old 09-14-2019, 09:11 PM
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Yes, agree with Tinyliny, request an MRI.

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post #7 of 18 Old 09-14-2019, 09:19 PM
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Pain to the point of vomiting is NOT ok. While nothing may be broken, I would be very worried about compartment syndrome from the crush injury.

I would add arnica to your medication regiment (got nothing to lose and it may help) and I would be back at the doctor's raising holy h#ll as the current plan is not working.
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post #8 of 18 Old 09-15-2019, 08:10 AM
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Be VERY careful with Compartment Syndrome, that's what nearly cost me my leg when Patti crushed my left foot. Just going on the pics you've posted, it doesn't look like that's set in or if it has it's not to a huge degree. When I had my foot crush and CS, I had swelling all the way from my foot up my thigh. Other things you're describing do sound like CS, but may not be. Beware of a doc who tells you, "You can't get CS from a foot injury.". BS, you sure can and it almost caused me a Below Knee Amputation. I ended up with 7 surgeries to remove dead tissue and bone chips (my metatarsals were mangled). I ended up on crutches for a year, no weight bearing at all during that time and even at the end of it, I could still barely get a flip flop on, could not put on a closed shoe or boot for probably close to 1.5 years and had severe pain & swelling in the foot even after several surgeries. From the XRays, I only see really one suspicious area but I'm not a radiologist, so take that with a bunch of salt. I would find another ortho doc and be really insistent about wanting an MRI.

Here's a link to a decent article about Compartment Syndrome, you want to read the acute information. Acute Compartment Syndrome The classic sign of acute compartment syndrome is pain, especially when the muscle within the compartment is stretched. The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain. There may also be tingling or burning sensations (paresthesias) in the skin. The muscle may feel tight or full. Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury.

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post #9 of 18 Old 09-15-2019, 09:02 AM Thread Starter
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Thanks all. This is my line of thinking as well.



Tiny I agree. He took the Percocet for the first three days but not seeing relief. Monday was Percocet only, Tuesday was percocet until late that afternoon when he got the tylenol and benadryl and then back to percocet for Wednesday with again a switch late in the afternoon. When staying with my mother codeine was prescribed for a cough he had. I am leery of it as he has had funny reactions to it when he was a baby. That is in his records but to them a suspected sensitivity even when two family members (one anaphylactic) have severe allergies to it is not enough to consider something else. He also reacts to benadryl if given several doses in a row but for a one time dose at night I know he'll sleep. With the way he is I didn't want to mix those two (codiene and benadryl). As he wasn't seeing relief or enough to matter to him we went with what we had. The 800 ibuprofen made more of a difference. I think it actually helped reduce swelling which was a big source of pain. He saw some relief with that.


The Urgent Care was concerned about compartmentalization but no mention from the ER. He has another appointment scheduled and will be evaluated this week by a P.T. I know, have worked with and trust. If he says MRI then the Dr will do as he asks so I will push for that.



Dream, thanks for the link. So sorry you had to go through what you did. One of our vice principals is going through similar. I don't know why they want to shuffle that possibility off to the side so quickly.
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post #10 of 18 Old 09-15-2019, 09:35 AM
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I agree with Dream catcher Arabian.

A friend on Facebook had her daughter crushed by an ATV that flipped over on her. She had multiple surgeries and was in and out of the hospital for weeks. Eventually made a full recovery but it was a very scary time.

If it is that painful i wouldn't walk on it. Rest, elevate, and use pain pills to control the pain.

I think an MRI would be a very good idea. The ortho doctor seems dismissive, even callous.

I pulled a ligament in high school. It took 2 years to fully heal. Probably did not rest it enough. If i walked on it too much it would swell. Soft tissue injuries are more serious than broken bones- they heal much slower and need a very long rehab time. Obviously you are familiar with how long tendon injuries take to heal in horses.

Call and request that MRI.
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