| Pioneering surgery offers the prospect of saving the legs of thousands of accident victims |
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| Health | |
| Written by Danny Penman | |
Yes, those bolts and wires really do go through the skin and into the bits of bone.
In May last year Danny Penman had a serious paragliding accident. Pioneering surgery saved his shattered right leg and ensured that he will soon be walking, running and flying again. Here he recounts life with the pioneering ‘Taylor Spacial Frame’ and his surgeon Mr Mark Jackson explains the procedure. THE PATIENT When my paragliding canopy collapsed and I plunged 30 feet to the ground I knew that I would be seriously hurt. Immediately after hitting the ground, I felt strangely calm and began methodically inspecting myself for damage. I touched my eyes to make sure that they were still in their sockets, moved my jaw to check that it wasn’t broken, and made sure there wasn’t any sticky yellow fluid coming from my ears. As soon as I checked my right leg I almost blanked out with the pain. I had visions of shards of bone poking through the skin, which as it turned out, wasn’t too far from the truth. When I reached hospital in Gloucester I was told that the shin in my right leg had splintered and been driven through into my knee joint. The doctor told me that it was unlikely that I’d ever again be able to walk without pain. Athritis was a certainty. If there were any complications I might even lose the leg. There was one glimmer of hope though, a new surgical procedure offered the possibility of reconstructing my leg and knee joint. The following week I was transferred to Bristol Royal Infirmery to have a Taylor Spatial Frame fitted to my leg. This device, whose use in the UK was pioneered by surgeons in Bristol, looks like a medieval torture implement. It consisted of four equally spaced aluminium rings that encircled my lower leg. Fourteen metal spokes and two bolts connected these rings to the shards of bone inside my leg. The spokes and rings of the frame can all move independently. This allows surgeons to move bone fragments around inside the leg. In essence, the Taylor Spatial Frame replaces both the traditional hospital ‘traction’, and the plates and screws currently used to fix severely broken bones. As a result, bones can be rebuilt or even progressively ‘stretched’ to lengthen limbs pulverised and shortened in accidents. The frame is a high-tech development of the equally grisly looking Ilizarov Frame. Life with the frame was very difficult. I could barely sleep and the pain was only controlled with powerful drugs, leaving me continuously washed-out and jaded. I managed to keep my spirits up by constantly telling myself that I would make a 100 percent recovery. I refused to allow any negative thoughts into my head. Each night I visualised myself running across open plains and climbing mountains. As I drifted off to sleep I would imagine a powerful bluey-white light sweeping up and down my leg, healing as it moved. I visualised the cartilage cells of my knee dividing, re-generating and repairing the damaged joint. I also prayed each night and probably for the first time in my life actually meant it. I also improved my diet. I eliminated all dairy products from my already vegetarian diet because they are thought to leach calcium from bones. I also reduced the amount of bread in my diet and made up for it with pulses such as lentils. I ate masses of spinach, cabbage, broccoli and oranges – all known to help bone growth. I also took a daily multivitamin, a calcium supplement, and glucosamine (with chondroitin) tablets, which are believed to aid joint health. I spent around 22 hours a week doing physiotherapy. At first it was agonising. Hardly a day passed without me collapsing in tears. I gradually regained use of my knee and the pain subsided to virtually nothing. After three months, I was allowed to start walking without crutches. It was one of the most important days of my life. I clearly remember gingerly touching the floor with my toe and wondering whether my leg would collapse under the weight. It didn’t and amazingly I felt no pain whatsoever. Six weeks later I had the frame removed and I am now even more determined to make a 100 percent recovery. I am still desperately weak but growing stronger by the day. In a few months I will start running again. And next year I plan to learn how to fly a glider. Almost every day I thank God that I survived. If my paraglider had been spinning a little faster or slower I would have landed upside down and been killed. Or perhaps I would have spent the rest of my life as a quadraplegic. For me, every day is now a bonus. THE SURGEON Mr Mark Jackson is a consultant orthopedic surgeon at Bristol University in the UK. When Danny was referred to me it quickly became apparent that his leg injuries were very serious. I have operated on 110 patients with similar injuries and his were in the top five. The tibial plateau, or lower knee joint, was broken into six main fragments. Part of the femoral condyle had been driven 10-20mm through the tibial plateau. Some of the resulting fractures ran deep into the tibia, or shin. In addition, the fibula was fractured. The most significant hurdle we faced was planning the operation. A CT scan revealed extensive soft tissue damage. This meant we had to make our incisions very carefully to ensure that we caused as little additional trauma as possible. We also had to time the surgery to fit in with the body’s natural healing cycle. Ten years ago, 70-80 percent of patients with Danny’s type of injury could expect complications ranging from wound breakdown to amputation. Now, largely because of improvements made in the planning of operations and the use of Taylor Spatial Frames, this has been reduced to around ten percent. The first part of the three hour operation consisted of reassembling the fragments of tibial plateau. These were secured with screws. We then reconnected the tibial plateau to the tibial shaft. A Taylor Spatial Frame was fitted to secure the bone fragments in place and reduce the fractures. 
Bone fragments can be moved progressively over a period of days or weeks and is achieved by altering the length of six struts in the centre of the frame. These adjustments are calculated by sophisticated computer software and the patient carries them out at home. The frames not only allow us to attempt surgery that was virtually impossible a decade ago but they have significantly reduced the associated trauma. This is a huge benefit to patients and is also proving to be very cost effective. It may cost £25,000 to fit a patient with a frame and provide all of the backup but studies in America show that an amputation costs the health and social services around £300,000. Although the surgery was crucial in helping Danny to walk again, the efforts of a huge support team were equally valuable. Our work would be wasted without the hard work of the specialist nurses and physiotherapists. Across the UK these services are simply not adequately funded despite them saving the NHS a small fortune.
If you think paragliding is dumb, take a look at these base jumpers!
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