Severe Fractures: Advances are Shortening Recovery Times

With a long list of scientific achievements to his credit, Robert Atlas, Ph.D., (pictured) is internationally known for his groundbreaking hurricane research and as director of the National Oceanic and Atmospheric Administration’s (NOAA) Atlantic Oceanographic and Meteorological Laboratory in Key Biscayne.

However, on Mother’s Day 2015, Mr. Atlas, an avid cyclist and tennis player, was indistinguishable from hundreds of riders on South Florida roads, as he pedaled down his favorite route through Coral Gables, after lunch with his wife and granddaughter. Halfway through what would normally have been a two-hour ride, he was approaching an intersection.  Seeing that the light was green, he proceeded.

“I was in the cross walk, and a lady in an SUV, making a right turn on red but looking the other way, saw her break in traffic and hit her gas,” he recalled. “I could see her face as she was driving into me. It was like shock, like she couldn’t believe I was in front of her.”

He was transported by ambulance to nearby Doctors Hospital with a severely fractured tibia.

“I know I was lucky that I wasn’t killed, because I very easily could have been,” said Mr. Atlas, who is also a former NASA research scientist and recipient of the NASA Medal for Excellence in Scientific Achievement. “I was also lucky that the medical treatments have advanced.”

Significant advancements in both surgical procedures and devices used to repair serious fractures have occurred over the past 20 years, decreasing recovery time and improving outcomes. Mr. Atlas’s story offers both hope for patients who experience severe fractures and a cautionary tale for motorists, particularly in Florida, as summer brings more cyclists to the streets.

Advancements Aid Recovery

Major fractures are not unusual among cyclists and other athletes, said orthopedic surgeon Christopher Hodgkins, M.D., of the Miami Orthopedics and Sports Medicine Institute, part of Baptist Health. Dr. Hodgkins specializes in conditions affecting the foot and ankle as well as treatment of sports injuries and fractures, and was called in to treat Atlas. Advancements, he says, can allow athletes and other patients to get back in play more quickly.

“In the old days they used to make a huge 20 centimeter incision, put big plates in there with screws, sometimes put a frame on the outside of the leg,” Dr. Hodgkins said. “Today, it’s minimally invasive. The patient ends up with a couple of very small incisions.”

Dr. Hodgkins performed a complex hour-long surgical procedure known as intramedullary nailing, in which a tibial nail ‒ a titanium rod ‒ is inserted into a small incision in the knee, and through the hollow part of the tibia bone all the way down to the ankle (see photo at left). It acts as an internal splint to realign and stabilize the tibia bone. Screws were then placed into the top and bottom of the rod.

“It provides an incredibly stable construct,” Dr. Hodgkins said. “It’s a mini-incision. It goes inside the bone, across the fracture and is secured at either end, and that restores alignment and stability.”

The procedure is easier on the body, he said.

“That’s another advantage to this percutaneous technique. We are not upsetting the blood supply at the fracture, because we’re not opening the skin and stripping all the tissue. We’re sneaking it by inside the bone so it leads to a much quicker healing time and recovery time.”

The sooner patients walk, he said, the faster the rehabilitation and return to normal activity.

“This is still an incredibly severe debilitating injury,” he said, “and it takes a good three to six months to recover simply because of the fracture, and injury to the muscles and soft tissue around the fracture.”

Mr. Atlas spent five nights in the hospital. Back at home, he began physical therapy. His progress was gradual at first, moving from wheel chair to walker and then to a cane. Known for his impressive work schedule, Mr. Atlas, still experiencing pain, worked from home. In addition to managing operations at the lab, he also gave a hurricane briefing to a member of Congress, and produced 12 articles for scientific journals during his time away. A few months later, he was walking a block, then a mile. Six months later, he was walking two miles. By November, he was playing matches for an hour and a half, but without running or jumping. Atlas, who has practiced karate since he was 15, was also doing karate stances and light kicking.

Sports Medicine and the Most Dangerous Place for Cyclists

Florida is the most dangerous state in the nation for cyclists according to a study released last year by the national Centers for Disease Control and Prevention (CDC). The report found that the state’s death rate of .57 per 100,000 was twice the national average. While the national fatality rate has improved overall, the National Highway Safety Administration statistics show that 50,000 people were injured in cycling accidents involving motor vehicles nationwide in 2014.

The CDC study also found that death rates for men were six times higher than women. It offered potential prevention measures, including more bike lanes, reduced speeds and speed bumps for drivers and education for motorists and cyclists.

In the meantime, Mr. Atlas is continuing to improve.

“It’s the running and jumping that were the major strong point of my game,” he said. Today, “my tennis is back to where it was before the accident, and my karate is almost back to normal.” One day soon, he plans to get back on a bike, although not on busy roadways.

While Atlas’s road to recovery may not have been unusual, Dr. Hodgkins said, the circumstances of his accident were. “I’ve dealt with hundreds of these, from incredibly severe to less severe, and most had other associated injuries, life threatening injuries. He’s very lucky.”