Two-Decade-Old Broken Bone Healed
July 19, 2015
Twenty years ago, a 20-something Anne Pfrimmer took to the road for her very first grown-up vacation.
But on a highway in South Carolina, her fun trip took a dangerous turn when she was hit head-on by another car that had crossed the median.
Anne was rushed to a local hospital with an open fracture of her tibia. To stabilize the bone and repair the break, surgeons inserted a titanium rod the length of her lower leg.
But the break wasn’t healing properly and examination by a local orthopaedic surgeon revealed an infection. Many additional procedures followed over several years—and Anne tried hard to return to her active life despite constant discomfort. But she now knows, “I walked around for 19 years on a broken leg and had accepted that it was as good as it would ever get.”
A Snowy Fall Becomes a Good Break
Fast forward to a snowy day in February 2014. Forty-three-year-old Anne, now a Washington, D.C., resident, took her beloved Labrador retriever, The Colonel, for a walk. She fell and knew instantly that the bone was severely reinjured. Luckily for Anne, a neighbor heard her cries for help. An ambulance took her straight to MedStar Georgetown University Hospital.
In the hospital’s Emergency Department, physicians found the impact of the fall had bent the metal rod to a 30-degree angle. The tibia had never healed. Anne would need surgery. “That’s when they called in the big guns,” says Anne.
She was sent home with an appointment to see MedStar Georgetown orthopaedist Francis X. McGuigan, MD.
“I was terrified I might lose my leg,” says Anne. “But Dr. McGuigan was so impressive. He explained every option. He had a plan for every possibility.”
Hope Comes in a Metal Frame
For Anne’s type of injury, Dr. McGuigan used a procedure that combines an advanced external fixation device, called the Taylor Spatial Frame, and computer-assisted surgery (Spatial CAD). “He was so confident this would work that I believed it, too,” Anne says.
Dr. McGuigan developed experience using the device and its computer applications while serving as a surgeon at the National Naval Hospital in Bethesda. He was one of only a handful of orthopaedic surgeons who used the procedure extensively to treat Marines who suffered severe lower-leg blast injuries in Iraq and Afghanistan. Now he is adapting it for patients with a number of complex orthopaedic problems.
“I thought Anne would be a good candidate for this surgery,” says Dr. McGuigan. “She had a chronic non-union—a compound break. Normally, the metal rod that was used in her leg would have compressed the bone, allowing it to heal. But Anne’s tibia never healed,” he explains.
During the procedure, Dr. McGuigan removed the bent metal rod from Anne’s leg, closed the incision and then affixed the frame to the outside of her leg.
The device is composed of two rings of metal with struts that join the rings. The computer calculates the precise length for the struts that will align the bone and encourage the body’s natural ability to grow healthy new bone tissue.
“After surgery, I wore shorts for nine months,” laughs Anne. “But I didn’t care. When the frame was removed in December, I was on my way to being free of pain for the first time in 20 years!”
Anne, who is back to work and walking The Colonel, knows that, if she had not been at MedStar Georgetown, the outcome could have been very different. “I got the expert. After the short surgery to remove the frame, I saw the grin on Dr. McGuigan’s face and knew the last months had been worth it. I’ll be forever grateful for the care I received,” she says.
To contact the MedStar Georgetown Foot and Ankle Center, call 855-546-0605 or visit MedStarGeorgetown.org/Ortho for more information.
Ankle Do Overs, Do Rights
Francis X. McGuigan, MD, and his colleague Paul Cooper, MD, are often called the “fixers.” They are the orthopaedic team of the MedStar Georgetown University Hospital Foot and Ankle Center, with special fellowship training in the repair of ankles—one of the most complex joints in the human body.
“Not every case we treat is complex. Often the injuries are more subtle, like an ankle fracture,” explains Dr. McGuigan. “In some cases, the fracture may have been repaired, yet the original procedure didn’t address damage to the articular cartilage, the super smooth joint surface that allows the ankle to move easily and painlessly.”
Dr. McGuigan often performs arthroscopic “revision surgery”— a minimally invasive procedure that results in less bleeding and a faster recovery. Using an arthroscope— a thin, flexible tube with a small camera—real-time images are captured on a video screen. He removes scar tissue and repairs the damage, which is often a joint surface that has been left rough following the first surgery.
“Right now, ankle arthroscopy is only done by a few surgeons, but in the future it will be the gold standard,” Dr. McGuigan adds. “We should do everything possible to get it right the first time to avoid unnecessary pain, a second surgery and possibly permanent limitations.”
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