Doctors Lounge - Orthopedics Answers
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Forum Name: Bone trauma and fractures
|darkmaya - Wed Apr 06, 2005 12:14 pm|
Hello, I would not like to name any places or names of people, but I have a question.
Someone close to me had a small spiral fracture in the leg bone just under the knee a year ago. He has been in a plaster cast for over a year now, and it has not healed. They are just now deciding to pin it.
He was in a 3/4 cast for over 2 months, and the last time when he went in for a check up and they decided to pin the leg, they removed the cast and the entire back side of his leg is black from skin rotting away. The staff simply cleaned the leg and gave him an antiseptic cream to administer to the black rotting portions of the leg.
Im assuming this is from not seeing to the patient or cast regularly.
Is this a case of negligence on part of the hospital and the doctors not scheduling enough care, or does this occur frequently?
Please help, Thanks.
|Dr. A. Saif - Thu Apr 07, 2005 4:18 pm|
It is difficult to say from here. If the skin is necrotic...i.e that the dermis and epidermis has died, then clearly it is a serious condition. It is unusual after a year from the injury, and more likely to occur a few days to weeks after the trauma. It is a result of the continued swelling of the leg, in a constraining full cast. Sometimes a DVT may cause the leg to swell in a tight cast and compromise the circulation to the skin, and this may lead to skin necrosis, but this too is rare.
After this long an interval and in an incomplete cast (your 3/4 cast, perhaps you mean that the cast goes three quarters of the way around the leg, and is open in the front?), this is extremely unlikely. The purpose of such a cast is so that the patient can remove the cast from time to time to bathethe legt and bend the knee, but still periodically support the leg. I presume though, as you seem to suggest that the leg hasn't been looked at for 2 months, it is not this kind of cast.
It is not unusual to have intervals of a couple of months between cast changes. Skin necrosis is painful and normally the cast wearer is able to inform the staff that something is not right.
It is more likely the "black skin" is the result of collected squames, that has been shed by the skin, but because these had nowhere to go, they formed a layer of crust over the real skin under neath, and will come of with bathing and antiseptic lotions. "Rotten skin" would require debridement and plastic surgery, and by the sounds of things, te situation is not so grave...
|darkmaya - Fri Apr 08, 2005 10:52 am|
By 3/4 cast I mean it goes 3/4 of the way up the entire leg...Before this last cast change he didn't have the problem except he felt his leg swelling up every now and then inside of it.
When they removed the cast last week, the "black skin" had accumulated at various points along the entire backside of his leg.
"they" said it was nothing to worry about, and gave a cream or what have you, but it looks worse and the skin just comes off in flakes and little clumps.
Is this an infection, or a rot, or can it become infected?
If it isn't rot and it is just dead squemas, how long will it generally take to go back to normal looking skin?
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