When a resident first starts getting handed the blade, it is always a scary feeling. After a while, it begins to feel more comfortable, and you become more in tune with how surgery is supposed to feel. But, when you have that first surgical mistake, an immediate wave of “oh no!” washes over you. For me, one of these times was when there was a revision hammertoe surgery.
The surgical plan was to fuse the second MPJ with a plate, since all other first line options had failed in this patient. Due to the multiple surgeries, there were some cortical irregularities on radiological evaluation, so a CT scan was ordered. Bone stock was specifically examined, and it was determined that the bone could support a plate fixation for the MPJ fusion.
During the surgery, the soft tissue releases and distal securing of the plate was performed without any issue. When the proximal plate fixation was being prepared, the drill was not able to pass through the plantar cortex. So, the attending said, “try pushing a little harder.” When I pushed harder, the plantar cortex broke, and the drill went through the bottom of the foot. Thankfully, no major structures were damaged, and the plate could be used to secure the metatarsal. However, this was definitely unexpected and one of the moments of residency that will stay with me.
When I pushed harder, the plantar cortex broke, and the drill went through the bottom of the foot.
Story by Dr. Grey
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