Management of an Open Crush Fracture to the Foot from a Lawnmower Injury: Case Report
This case report from *The Foot & Ankle Online Journal* (December 2020) details the clinical journey of a patient sustaining a high-energy open crush fracture to the mid- and forefoot—caused by a lawnmower. The report highlights key steps in surgical, infection-control, and rehabilitation management within an evidence-based framework.
Case Overview:
- Injury Description: The patient presented with an open fracture involving multiple metatarsals and cuneiforms, with accompanying soft-tissue loss and heel pad damage—characteristic of high-energy lawnmower trauma.
- Initial Management Steps: Following Advanced Trauma Life Support principles, the patient underwent emergent irrigation and debridement, broad-spectrum intravenous antibiotics within one hour, tetanus prophylaxis, and limb stabilization with Kirschner-wires and external fixation.
- Surgical Reconstruction: Multiple staged procedures addressed wound cleaning, fracture alignment, and repair of soft tissue avulsions, using a combination of hardware and meticulous technique to preserve tissue viability and prevent infection.
- Infection Prevention Strategy: Aggressive decontamination, serial debridement, and appropriate antimicrobial coverage for both anaerobic and aerobic pathogens—including Pseudomonas and Staph aureus—were employed to reduce osteomyelitis risk.
- Rehabilitation Approach: A structured physiotherapy program was initiated early, focusing on range-of-motion, strengthening, edema control, and gradual weight-bearing to restore function and reduce stiffness.
Clinical Takeaways:
- High-risk open crush injuries require immediate, protocol-driven intervention to minimize complications like infection and non-union.
- Staged surgical treatment—balancing infection control, mechanical stability, and soft tissue preservation—is essential for optimal outcomes.
- Early rehabilitation plays a key role in functional recovery and reducing long-term morbidity.
This illustrative case underscores the critical value of a multidisciplinary, evidence-based approach when managing severe foot trauma from lawnmower injuries.
Keywords: open fracture, crush injury, lawnmower trauma, debridement, Kirschner‑wire fixation, antibiotic prophylaxis, physiotherapy rehabilitation