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Getting over severe injuries
Bleeding and cold, Tara Burr couldn't move her legs. Still strapped into the remains of her crumpled car, which had just plunged 15 feet off a freeway exit ramp, she managed to call 911. Her first inkling of the severity of her injuries came when the paramedics informed her that her left foot was pointing in the wrong direction.
Over the next few days, as she drifted in and out of consciousness, she recalled hearing physicians tell her family that "things look bad" and "it's unlikely she'll ever walk again." Burr, now 26, suffered two broken ankles and a fractured pelvis in the crash. Her left leg also was broken. Her parents requested that Burr be transferred to Memorial Hermann-Texas Medical Center so that Kyle Dickson, MD, could put the pieces back together.
Dickson, chairman of the Department of Orthopaedic Surgery at The University of Texas Medical School at Houston, had recently moved from New Orleans, where he was director of orthopaedic trauma at Tulane University. He brought with him to Houston a surgical technique that would help Burr get back on her feet. Dickson, who specializes in complex fractures of the pelvis, hips, legs and ankles, worked to realign the broken bones in Burr's pelvis and leg. Her left ankle was the injury that concerned him the most.
Burr had suffered a high-energy tibial plafond fracture, which is typically seen in a patient who survives a motor vehicle accident or a fall from more than 10 feet. This injury is much worse than a simple ankle fracture. Essentially, because of the impact of the accident, the ankle joint becomes jammed up into the lower leg, crushing the joint into as many as 20 pieces. Life and limb not equally protected Before air bags were installed in vehicles, patients who suffered severe plafond fractures in crashes often didn't survive their other injuries, Dickson says.
The added safety feature does a remarkable job of protecting drivers and passengers from fatal head and chest injuries, Dickson explains, but it leaves their lower extremities vulnerable to severe damage. As air bags began to save lives, orthopaedic surgeons began to see more and more of severe plafond injuries. Initially the surgical approach was an "open" procedure (traditional surgery) using hardware such as screws to put the bones back together. Called an open reduction with internal fixation, this technique had a high rate of infection and amputation, and mobility outcomes were poor.
External Fixation How this leg was saved Dickson, chief of orthopaedic trauma at Memorial Hermann-TMC, sought to improve patients' chances of walking again. He developed an external fixator to help stretch the crushed and shortened leg back into its normal position. Dickson attaches the frame to the leg with pins between the ankle and the shin. Then he waits for the swelling around the ankle to diminish. Operating too soon before the soft tissue has had time to heal can be detrimental to the patient's recovery, Dickson says. When the swelling is under control, he operates, carefully working with screws and plates and using the external fixator to put the delicate pieces back together.
The technique not only helps patients walk again but also decreases the risk of developing arthritis in the injured joint. Patients continue to wear the external fixator for several months before Dickson allows them to put weight on the injured ankle. Dickson says that even after the frame comes off, patients with plafond fractures usually continue to heal and improve for a year after the initial injury. Burr's car crash happened in December 2006. In March, she took her first steps in the frame.
She continued to wear the external fixator until the middle of April, and Dickson removed the frame just in time for her twin sister's wedding. "Initially they said I would never be able to walk again, and if I did it would be with some assistance a cane or a walker," Burr says. "Thankfully there are people like Dr. Dickson who can help people walk again." Burr now walks tall and proud without any assistance.
She may not be able to play sports again, and her toddler sometimes gets around faster than she does, but she counts her blessings. In a transparent plastic bag, Burr keeps the external fixator that helped her to walk again. It reminds her of the 15-foot fall. It reminds her to never give up. It reminds her that there are people out there who can help.
