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Ask Dr.Sawhney Your Own Question
Dr.Sawhney, Orthopedic Surgeon
Category: Orthopedics
Satisfied Customers: 7240
Experience:  More than a decade of post qualification experience
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Dr. Sawhney Only -- I would like to ask you a new question

Customer Question

For Orthopedic Surgeon Dr. Sawhney Only -- I would like to ask you a new question if you are available. Please respond and I will reply with the specifics as well as photographs. THANK YOU!
Submitted: 8 months ago.
Category: Orthopedics
Expert:  Dr.Sawhney replied 8 months ago.
Please go ahead and ask your question.
Customer: replied 8 months ago.
On 12-Dec-2016, you viewed a photo I submit of a dislocated index toe and opined that it should be reset, either with or without invasive surgery. The toe initially had an open wound on the left hand side (ulcer based on clipping of dead skin) but such has healed, for the most part. The toe was red and swollen for a number of weeks and oral antibiotics were prescribed and taken. The girth of the toe shank to near normal size and one of the home care nurses that came by to treat the toe (change dressings apply antibiotic ointment) opined that the toe would likely become fully healed by the end of January 2017. But then the toe swelled up again and began to discharge a small amount of blood. The skin is not as red as before and is not giving off any heat or odor. But it appears that one or more bones (phalanges) may be moving around or that there has been a build-up of cartillege. The 27-year wound care nurse treating this toe is concerned that one or more bones may have become infected. We have discharged the surgery-capable Podiatrist that initially treated this toe with just Collagen and ointment for 13 weeks, then prescribed complete removal of one or more phalanges claiming "dislocated toes cannot be reset" which you disagreed with on 12-Dec-2017. We are now seeking evaluation and treatment by a Board Certified Orthopedic Surgeon in a larger city 500 miles away. But based on the attached photos, do you believe the bones of this index toe have become infected? Should the bones be removed, reset, or pinned? What is your diagnosis / recommendation for treatment? Note the patient is an 87 year old female in generally good health but has Chronic Obstructive Pulmonary Disorder (COPD) and is taking daily Spiriva inhalers for same; an Irregular heart beat (Arrhythmia since childhood / moderated by Coumadin / blood thinner to prevent stroke or heart attack), occasional high blood pressure (kept within therapeutic range via medication), and Hypothyroidism (moderated by Levaquin.)
Expert:  Dr.Sawhney replied 8 months ago.
Thanks for the detailed question.
Looking at the photograph it is quite possible that one of the bones has gotten infected.
This would need to be confirmed by X rays of the toe and markers of inflammation like ESR and CRP quantitative.
If one of the bones is infected removal of that bone maybe considered. Resetting of an infected bone does not serve any purpose as removal of infection is our primary target in any infection.
Feel free to ask any follow up questions.