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What is Lower Extremity Trauma?
Lower extremity trauma refers to serious injuries to your legs, ankles, or feet. These can range from a broken bone (like a broken ankle) to very complex injuries affecting multiple parts of your limb. At Orthopedic Specialists, we understand that these injuries can be life-changing, and our goal is to help you achieve the best possible recovery.
Treating these complex injuries requires a team approach. Our experts work closely with general surgeons, vascular surgeons (for blood vessel issues), plastic surgeons (for skin and tissue repair), and rehabilitation specialists to ensure you receive comprehensive care. Even with a severe foot injury, our primary aim is always to try and save your limb whenever possible.
How We Evaluate Your Injury
When you come to us with a leg injury, we thoroughly examine four key areas of your lower extremity:
- Nerves: To check sensation and muscle movement.
- Blood Vessels: To ensure proper blood flow.
- Bones: To identify any fractures or dislocations.
- Soft Tissues: Including muscles, skin, and tendons.
If three or more of these areas are significantly injured, we refer to it as a mangled extremity. Our detailed evaluation, often including X-rays and other imaging, helps us understand the full extent of your lower extremity trauma so we can plan the most effective treatment.
Understanding Your Foot and Ankle Anatomy
To better understand your foot or ankle injury, it helps to know how these areas are structured:
- Bones: Your foot and ankle are made up of 26 bones that support your body and allow movement. Key bones include the talus (which connects to your leg), calcaneus (heel bone), and the many small bones that form your arch and toes. These bones work together to absorb shock and provide balance.
- Muscles and Tendons: Muscles in your lower leg and foot control movement, while tendons connect these muscles to the bones. The Achilles tendon, for example, helps you walk, run, and stand on your toes.
- Nerves: Important nerves like the tibial nerve and peroneal nerve help control movement and provide sensation to your foot and ankle. If nerves are damaged, it can affect your ability to move or feel certain parts of your foot.
- Blood Vessels: Arteries deliver oxygen-rich blood to your foot, while veins carry blood back to your heart. Injuries to these vessels, called vascular injuries, can be serious and require immediate attention to preserve tissue and function.
Understanding how these structures work together helps explain why proper diagnosis and treatment are essential for healing and recovery.
Procedures for Lower Extremity Trauma
Our main goal with orthopedic surgery for lower extremity trauma is to help you regain the best possible function of your limb.
Damage Control Surgery
For patients with very serious, life-threatening injuries, we may use a damage control approach. This means we focus on quickly controlling any major bleeding and stabilizing bones temporarily (often with external splints or frames) to ensure your overall safety before moving to more definitive repairs. Your survival is always the first priority.
Managing Bleeding (Vascular Injuries)
Blood vessel injuries are critical. For minor injuries, we might ligate (tie off) a vessel if other blood vessels can still supply blood to the limb. For more significant vascular injury, we prefer a temporary shunt. This is a tube inserted into the vessel to keep blood flowing past the injury, giving us time to stabilize you before a full repair. Restoring blood flow quickly is vital for limb salvage.
Preventing Infection
Infections are a major concern with severe injuries, especially open wounds. We take infection control very seriously:
- Antibiotics: You'll receive antibiotics early to prevent serious infections like osteomyelitis (bone infection).
- Cleaning Wounds: We perform thorough surgical debridement (removing damaged or contaminated tissue) and irrigation (washing the wound with saline solution) to clean the area.
- Local Antibiotic Adjuncts: Sometimes, we place antibiotic-impregnated materials directly into the wound to deliver medication locally and prevent infection.
Fixing Fractures (Bone Management)
Stabilizing your broken foot or other bone fractures is crucial for healing and overall limb function. Often, we start with an external fixation device, which is a frame placed outside your leg with pins going into the bone to hold the fracture still. Once your overall condition is stable and the soft tissues are healing, we may proceed with definitive fixation, which could involve placing a rod (intramedullary nail) inside the bone or plates and screws to hold the fracture permanently.
Restoring Blood Flow (Revascularization)
Restoring blood flow to your limb, known as revascularization, is essential. We work quickly to repair damaged arteries and veins. This might involve sewing the ends of the vessel together or using a piece of your own healthy vein (often from an uninjured leg) as a bypass graft to restore continuous blood flow. The sooner blood flow is restored, the better the chances for limb salvage and recovery of nerves and muscles.
Releasing Pressure (Fasciotomy)
Sometimes, after a severe injury, swelling inside the muscle compartments of your leg can build up dangerously, cutting off blood flow and damaging nerves and muscles. This is called compartment syndrome. To prevent this, we might perform a fasciotomy, which involves making incisions to release the pressure. This is a critical procedure to protect your limb.
Nerve Repair
If nerves are cut or damaged, we will evaluate the best approach for nerve repair. Sometimes, we can repair them directly during surgery, or we might mark the nerve ends for a later, more specialized repair once other injuries have healed. While nerve healing can be a long process, our goal is to restore as much function and sensation as possible.
Limb Salvage vs. Amputation
The decision to save a limb (limb salvage) or perform an amputation is one of the most difficult and important choices. Our team always strives for limb salvage if it's safe for you and offers a chance for good function.
In most cases, we will try to save the limb, even if the injury is very severe. This approach allows time for you and your family to understand the situation and make informed decisions if amputation becomes necessary later. Attempting limb salvage can often lead to better long-term outcomes and can even be more cost-effective than immediate amputation.
However, in some rare, severe cases where the tissues are too damaged or if the injury threatens your life, primary amputation might be the safest and most functional option. We will discuss all possibilities openly and honestly with you.
Rehabilitation and Beyond
After orthopedic surgery, your journey to recovery continues with comprehensive rehabilitation. Our team works with physical and occupational therapists to help you regain strength, flexibility, and function in your injured limb. We'll guide you through exercises and activities designed to help you get back to your daily life.
Complications can sometimes occur, but our team at Orthopedic Specialists is highly experienced in identifying and managing them early to ensure the best possible outcome for your lower extremity trauma.
Expert Foot & Ankle Care
Don’t let foot or ankle pain keep you from living fully. At Orthopedic Specialists, we are dedicated to providing expert, compassionate care for all types of lower extremity trauma. Whether you’re dealing with a recent trauma or chronic discomfort, Dr. Nathan Hensley, DPM, and our foot and ankle team at Orthopedic Specialists are here to help. Using advanced diagnostic tools and working closely with physical therapy specialists, we develop personalized treatment plans to get you back on your feet. We’re ready to provide the expert care you deserve.
