Cheilectomies and hallux limitus patients are one of the “bread and butter” cases of podiatry. This patient was a classic cheilectomy case. She had failed conservative treatment and had continued pain with 1st MPJ range of motion. Radiographs showed clear evidence of 1st MPJ osteoarthritis and osteophyte formation at the 1st MPJ.
Initially, everything in the case was going well. I resected the medial and lateral sides of the joint without any issues. I began to start the resection of the dorsal aspect of the metatarsal, but my hand wasn’t dropped enough. As I was making my cuts, the saw blade was continuing into the shaft of the 1st metatarsal. My attending noticed this and asked for the saw. I handed my attending the saw, and he tried to cut dorsal cortex of the metatarsal shaft from dorsal to plantar (perpendicular to the metatarsal). As soon as he started making this cut, the whole first metatarsal fractured. Both of us just stood there for a second trying to absorb what had just happened. We had to plate the first metatarsal and keep the patient nonweightbearing for 6 weeks. It was a big lesson for me to expect the unexpected in surgery and to have a plan for as many mishaps that you can think of.
As soon as he started making this cut, the whole first metatarsal fractured. Both of us just stood there for a second trying to absorb what had just happened.
Story by Dr. Seuss.
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