For nine months, Dan Ryder lay flat on his back, praying and trying to remain positive that he would one day walk again.
On a clear afternoon last fall, Ryder was cruising home from his job as a crane operator when the driver of a truck failed to stop at an intersection. Ryder was thrown from his motorcycle and landed on the highway. His pelvis was shattered; his bike totaled.
Surgeons initially put pins in his hips and an external fixator around the pelvic area to stabilize it. Only time would tell if he’d make a full recovery.
After months at Clear Lake Rehabilitation Hospital, Ryder learned that the pelvis hadn’t healed properly. Called in to consult on Ryder’s case, Kyle Dickson, MD, chairman of the Department of Orthopaedic Surgery at The University of Texas Medical School at Houston had good and bad news.
“I asked for the bad news first, and I was told they were going to have to rebreak my pelvis,” Ryder recalls. “I cried. It was devastating.”
The good news was that Ryder would be under the care of a leading expert in pelvic reconstruction. Dickson’s plan was to perform a novel, three-stage surgical approach that would help get Ryder back on his feet.
During the first stage of the surgery, patients are positioned on their backs. Dickson makes an incision above the pubis and another in the area of the hip. He works to release the ligaments, nerves and scar tissue that have been holding the pelvis in an unstable position. Then he performs osteotomies to break the bones along or close to their original fracture lines.
After closing up the incisions, during the second stage, Dickson turns the patient onto his or her stomach. He again releases ligaments, nerves and scar tissue so that he can move the pelvis back to its correct anatomical position.
“It’s critical that we get the pelvis back to the position it belongs in,” Dickson says, chief of orthopaedic trauma at Memorial Hermann-Texas Medical Center. “Otherwise, the patient will have pain and may be unable to walk or even sit.”
Dickson uses screws to put the fractured bones back together. Then he closes up the incisions, returns the patient to his or her back, reopens the incisions in the front and affixes a plate to the front of the pelvis. This is the third and final stage of the surgery.
Dickson recommends the multi-stage pelvic reconstruction when initial treatment has failed or when the patient’s pelvic injury has been left untreated for a period of time. “It’s difficult for patients to hear that we have to break the bones again and start over, but most of them are miserable and in so much pain, they are willing to try it,” Dickson says.
In his medical career, Dickson has performed more than 100 three-stage pelvic reconstructions. In all cases, the patients have walked again. Only one has chronic pain stemming from nerve damage, says Dickson, who first reported success with this surgical approach in 1996 in Clinical Orthopaedics and Related Research.
The complex surgery often takes up to eight hours, and there is a risk of bleeding and/or nerve damage. The recovery also is lengthy. Patients usually are in the hospital five to seven days after surgery, and they are not allowed to put any weight on the pelvis for three months.
“I was strictly on my back,” Ryder recalls. He spent that time reflecting on his life, strengthen his faith and relishing the opportunity to be with his wife and their family, which includes four children, 10 grandchildren and one great grandchild.
“It sure paid off,” says Ryder, age 58. “I’m doing a lot better than people thought I would. I’ve been so blessed. Dr. Dickson fixed me up good. Dr. Dickson, his staff, my wife, everyone at Clear Lake Rehab, they all did real good.”
In June, Dickson gave Ryder the thumbs-up to stand up. With the help of a walker, he took his first steps. He is now in physical therapy two to three times a week at Clear Lake Rehabilitation Hospital to regain full mobility. He still requires a walker or cane, but he’s confident he’ll be able to walk without assistance and return to work in the upcoming months.
“I always knew I would walk sooner or later,” Ryder says. “I’ve come a long way, and I’m really looking forward to what’s ahead.”
UPDATED: 8-29-2007
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Dr. Kyle Dickson is chairman of the Department of Orthopaedic Surgery at The UT Medical School.
Microwaves and 'Erupted Hot Water Phenomena'
Hot-water eruption can occur if you use a microwave oven to super-heat water in a clean cup. ("Super-heated" means the water is hot beyond boiling temperature, although it shows no signs of boiling.)
A slight disturbance or movement may cause the water to violently explode out of the cup. There have been reports of serious skin burns or scalding injuries around people's hands and faces as a result of this phenomenon.
Adding materials such as instant coffee or sugar to the water before heating greatly reduces the risk of hot-water eruption. Also, follow the precautions and recommendations found in microwave oven instruction manuals; specifically the heating time.
