PHYSICIANS ON THE FRONT LINE
Figure 1 - Preoperative and postoperative radiographs of ankle
replacement in a retired Airborne infantryman. Figure 2 - Postoperative radiograph following cavovarus foot
reconstruction and fifth metatarsal base screw fixation in a 50-year-old
University ROTC instructor.
I completed Airborne School in 1979, making the required five
static line parachute jumps to earn my “Jump Wings.” One of my
recent retired Army patients was an old paratrooper who developed
ankle arthritis resulting from fractures sustained parachuting in
the Airborne Infantry. He had made hundreds of parachute jumps
with heavy equipment strapped to his body and was also qualified
as a Jumpmaster. A Jumpmaster directs paratroopers to jump out
of the plane at the correct time to reach the drop zone. He also “en-
courages” soldiers who have second thoughts to leave the aircraft.
My patient was a likeable colorful character who proudly still wore
his Airborne Wings on his hat. I was able to perform a successful
ankle replacement and relieve his ankle pain (see Figure 1). He is
still pending bilateral knee replacements. His physical sacrifice
continues into his retirement. soldier is Achilles tendon rupture. This injury is most common in
the third and fourth decade and usually occurs after stepping in
a hole or while playing basketball. Standard open repair can be
achieved through a relatively small incision, although minimal
incision techniques are also successful. Outcomes from treatment
of this Achilles tendon rupture are excellent.
Wartime limb injuries can be devastating and may lead to am-
putation. With improved body armor and helmets, soldiers may
survive blast injuries only to be left with one or more amputated
limbs. Amputees can have problems with phantom pain, prosthesis
fitting and stump neuromas. I recently treated a Vietnam veteran
who had ongoing problems with pain in his above the knee am-
putation stump. He was unable to wear his prosthesis due to pain.
MRI documented a neuroma of the sciatic nerve. I was able to
resect the painful neuroma, which allowed him to continue use of
his prosthesis.
Most of my active duty patients have ankle injuries from recur-
rent ankle sprains or fractures sustained while running on uneven
ground. Talar osteochondritis dessicans lesions and painful ankle
loose bodies are easily treated with ankle arthroscopy. Recurrent
lateral ankle inversion instability requires lateral ankle reconstruc-
tion, usually with allograft tendon, to anatomically reconstruct the
anterior talofibular and calcaneofibular ligaments through drill holes
in the talus and fibula. Another common injury in the active duty
Some patients are born with a foot structure that predisposes
them to injury. Most obvious pre-existing conditions are grounds
for denial of entrance into military service. Some subtle deformities
may be overlooked or waived. A 50-year-old retired Army Sergeant
First Class with 20 years active duty experience saw me for lateral
foot pain. He had a history of two previous foot surgeries. He had
a cavovarus (high arched foot) and walked on the lateral border of
his foot. His abnormal foot structure had caused chronic tears of
his peroneal tendons and a fifth metatarsal base stress fracture. He
had failed multiple attempts of physical therapy and orthotics. This
patient required triple arthrodesis and first metatarsal base closing
wedge osteotomy for correction of his deformity, screw fixation
of the fifth metatarsal, and repair of peroneal tendons (see Figure
2). Recovery from this extensive surgery required three months of
nonweight-bearing. Total recovery will take one year. He is now
five months postoperative and is back at his job as a university
ROTC instructor.
As Veterans’ Day again is celebrated this month, let us take time
to acknowledge the many sacrifices of our active duty personnel
and retirees. If you are fortunate enough to treat them as patients,
remember that their service is what keeps our way of life safe and
secure.
Dr. Hockenbury is an orthopedic surgeon with KentuckyOne Health Orthopedic
Associates.
NOVEMBER 2019
13