MANILA ADVENTIST MEDICAL CANTER AND COLLEGES

Degloving Injury
Tibio Talar Dislocation

A partial fulfillment for

Orthopedic Affiliation

by
Esfer Grace Angela E. Fernando
Fourth year Nursing
Section B, Block 10B
I.PATIENT’S PROFILE WITH DEVELOPMENTAL TASK

This case is about Mr.Delta, a 23-year old man. He is a half-Chinese and half-
Filipino. He lives in Binan, Laguna with his wife. He is the youngest in the family. He likes
playing basketball and hanging out with friends.
Erik Erickson
He belongs to young adulthood which is Identity vs. Isolation, he is sure of his own
self and he already plans for his family and he knows his own strengths.
Sigmund Freud
He belongs to genital; he can cope easily to his environment and eager to have
friends.
Robert Havighurst
He belongs to early adulthood. He is married but no child. He is starting to find a job.
Lawrence Kohlberg
He belongs to adulthood. He is aware of rules and laws here in our county. He is able
to follow the laws and never committed any sins against the law.

II.PAST MEDICAL AND FAMILY HISTORY

This is his first hospitalization. He had fever when he was a child and his teenage
years, but never admitted; just in nearby community health center. Paternal and maternal
side has both HPN and heart problems.

III. HISTORY OF PRESENT ILLNESS

Several hours prior to admission, he was back riding when it was hit by a jeepney
and was ran over by a truck on his right left lower extremities. He was bought to a nearby
hospital and was advised to Philippine Orthopedic Center.
He undergo three surgeries: June 23, 2010 – wound debridement + external fixator
June 30, 2010 – repeat debridement
July 6, 2010 – debridement of thigh
th
** Possible 4 surgery for skin grafting

As of July 11, 2010, his diagnostic results are positive gram stain ad there are few
cocci seen. Last July 22, 2010, he was transferred to isolation room due to infection –
Pseudomonas. He has delta frame to support his ankle, carpals and metacarpals not to be
dislodge. He was given pain killers, anti-tetanus and anti-bacterial drugs.
IV. PATHOPHYSIOLOGY
 Separated Soft Tissues from deeper tissue layers
(Degloving Injury)

Depleting blood supply

Rupture of the calf Rupture of the tendo achilles

Pain swelling brusing inability to maintain a tiptoe position

Dorsiflexion of the foot

Fracture of the neck of the talus

Subtalar dislocation with ankle

Dislocation of the calcaneum

Total dislocation of the talus

Explanation:
 When soft tissues are separated, it is commonly that the thigh, tibia and talar are
affected and often dislocated. In the rupture of the calf or what we call Tennis leg, the cause
is always due to a sudden calf contraction in response to effort, such as leaping a high ball
or any vehicular accident. The result is dramatic and devastating. There is immediate pain
and excruciating pain in the mid-third of the calf and can’t able to walk easily. The rupture
is in the gastrocnemius and swelling and bruising of the calf becomes apparent within an
hour or so of the injury. The same injury is also responsible for the rupture of the achillis
tendons. Because of the inability to maintain a tiptoe position the patient adopts a flat-
footed, plodding type of gait, and completely loses the active plantar flexion against body
weight. The fracture of the neck of the talus, it arises from the forced dorsiflexion of the
foot. It must be understood that only the posterior half of the subtalar joint is dislocated.
There is usually no displacement between the head of the talus and the anterior facet of
calcaneum. Described in full the injury is a fracture of the neck of the talus with dislocation
of the posterior half of the subtalar joint, and the final degree of displacement of the body
of the talus. The last degree of injury is described as fracture of the neck of the talus,
subtalar dislocation with backward displacement of the body. The talus is liable to
dislocation because it is the only bone in the leg without muscle attachment and because
more than half of its structure of its surface is articular.

Entrance to the host occurs through open wounds. While a few organisms can grow at the
initial site of entry, many invade and start to grow in different organs where they are hard
to detect. Some organisms grow within the host cells whereas others grow freely in blood.
It is a Pseudomonas. For an organism to cause disease, there are several factors that must
be met before an infection can occur. The organism must be able to grow, multiply, be able
to enter the body and have the ability to cause disease. Infectious agents which cause
disease in humans include bacteria, viruses, parasites and fungi. Reservoir is a place where
organisms can thrive and multiply. This may be either inside the human body or outside
like in an inanimate environment. In order for micro organism to survive and repeat the
cycle of infection in other humans, it must have a way to exit the reservoir. Direct contact
infections can also result from inhalation of infectious organisms found in aerosol particles
emitted by sneezing or coughing. In this case, it enters via breaks in the skin, a surgical
incision or a laceration. The patient has suppressed immune system are quickly over
powered by the organisms.

V.EVALUATION

Mr. Delta has improvement. Dr. Jose said that there are improvements in his
treatments because the loss tissue in his lower extremity is processing and it’s in the
process of healing. He was just disappointed when the doctor said that he has infection due
to his co-patient, so he was transferred to isolation room. He is depressed because of
financial needs and little angry to the driver of the motor because the driver promised that
he will the pay of the bill of the hospitalization but he can’t contact the said driver.
As a whole, he is still happy because his family is there to support him in times of
situation like this. He still thanking God and he’s faith to God is still strong. He is very
excited to go home, so he is really active to the techniques’ or treatments for him to be okay
again.

References:

*Books
Berman, Snyder, Kozier, Erb: Fundamentals of Nursing.11th Ed. Volume 1
Doenges, Moorhouse, Geissler-Murr: Nursing Care Plans. Ed.6
Johnson, Joyce Young: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.
RN, PhD, 11th Ed.
Watson-Jones, R: Fractures and Joint Injuries. Edited by J.N. Wilson, 6th edition, Volume
1&2.

*Internet
http://www.scribd.com/
http://www.ask.com/
http://www.google.com/
http://www. medicaldictionary.php.htm/