A young female athlete girl breaks her leg playing soccer. After treating the fracture the doctor sees the potential of a more serious condition and calls her back. While he is doing the tests she begins to study the diagnosis, treatment and outcome of the treatment and in doing so she encounters something disturbing. Are all the surgeries being done for this condition necessary?
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Laura Durin’s alarm went off at 6:00. Within seconds she rolled to edge of the bed, turned off the alarm, extended her feet toward the floor and stood up in one graceful movement. She turned on the light, moved to the open area in her room and started counting off exercise repetitions. She was in great shape physically and mentally. Last year was a great one for her on the basketball court and the soccer field. This year was shaping up to be much better.
She was in better physical condition than last year and improving that every day. She knew the games better and she knew herself better. With her exercise finished she pulled on her bathrobe and headed for the bathroom the seventeen year old girl shared with two younger brothers. Laura hated sharing the bathroom. Anything she left there was fair game. The bathroom might as well have been a no man’s land. She never knew what to expect from these two.
She grabbed a towel and washcloth from the linen closet, entered the bathroom, cast off her pajamas and turned on the shower. Before six twenty her makeup was done and she was putting the finishing touches on her hair. Everyone who knew her called her a blond beauty. Five minutes later she was dressed, her computer was on, and she was working on a report for an English Class. Her mom dropped a cup of tea, a glass of OJ and a bagel on her desk about seven.
About seven thirty she saved her data and turned off the computer. It was time to head for school. She grabbed her books and headed downstairs. Her brothers were waiting. She sounded like a drill sergeant as she headed them to the car and started for school.
Today Laura’s second period class was Physical Education. She dressed and assembled with the other girls. As she stood waiting for the teacher to take roll she rubbed her hand down over her right leg. She had become aware of an ache in it over the last few days. Actually she did not have any idea when it started but it had come and gone now for at least two weeks. As she stood there she mused that it seemed like it was getting more frequent and intense. Maybe she should mention it to the coach. Before she could contemplate further on the subject the coach called them to start the soccer game.
Laura played forward, for her there was no other position. Although she was tall and very fast she was had retained the agility to play this position. Conditioning had developed her stamina. There were few players who could run as fast or as long and none of those could also run the intense patterns. She was a scoring threat every time she got near to the ball and every team they played knew it. As a Sophomore last year most of the other teams developed a respect for her ability.
On the field, whether in practice or a game, she was intense and aggressive. About five minutes into the game Laura took a pass and was heading toward the goal dribbling the ball. Two opposing team members were trying unsuccessfully to wrest the ball from her. As she approached the goal she attempted a kick with her left foot. The coach was watching. This was normally an easy score. Laura had a knack for determining the end of the goal the tender was not able to defend and then was able to place the ball at that end.
The coach gasped as the ball left Laura’s foot and just seemed to roll toward the goal with no particular direction and very little speed. Laura had just missed a relatively easy kick. Her usual shots were fast, precise, determined. Then the coach realized Laura was falling. Something was terribly wrong with Laura. The coach started running toward the place Laura lay crumpled on the ground.
As Laura took the pass she was aware that the pain in her leg increased significantly with every step. Each time she landed on her right foot there was a shooting pain throughout her whole leg. “Five more steps, then a kick, and I stop to let the coach look at it.” She thought as she took the next step. Four more, get the ball into position to kick, three more, ball coming back to position, two steps, there it is, kick. She had just started to put her weight on her right foot and her left foot was starting its sweep toward the ball when she heard the snap.
It was like something just broke, her right leg pained and she realized it was no longer supporting her as she fell. Her left foot hit the ball momentarily on the way down but it lacked the energy without the leverage of her right leg. She landed on her right side, she felt the skin of her right arm burn and tear as she slid to a stop. Her leg hurt. She reached her left hand out to touch her right leg and realized the knee was in a strange place. As she was trying to sort this out, she realized the coach was standing over her.
“Laura, lay still.” The coach had already seen the unusual position of Laura’s right leg and wanted her to remain still. There obviously was either a bad dislocation of the knee or a break just above it. Either way, it was best to be still. The coach did an ABC. A, her airway was open. B, Laura was breathing. C, there was no visible bleeding except a small cut on her arm. The immediate taken care of the coach pulled her cell phone off her belt and dialed 911. Laura was hurt and in pain.
Getting help was the first priority. Notifying the office could wait. She gave the information to the 911 dispatcher and hung up. She dialed the nurse’s office and asked her to come to the soccer field. Laura’s needs were now being addressed. The coach next dialed the school office and notified the principal. He verified that she had already called 911 and the school nurse. He also asked for the injured student’s name and advised that he would be there immediately. She mused that he would probably be in the way.
Coach Lackey knelt next to Laura and held her hand. “Just be still, it hurts, I know, but it is best to be still.”
“I screwed up bad.”
“How’s that, it wasn’t your fault.”
“But my leg has been hurting, I ignored it. You told us to never ignore something that hurts.”
“So we get you to the hospital and have them fix you up.”
“This isn’t just a muscle strain. This is bad news. I heard the bone break.”
“You can’t be sure, a joint popping out sometimes makes a noise too. You can play with a knee brace if you have some stretched tendons.”
“I know it’s broke, if I even move a little something grinds.”
The coach looked up. She could see the principal and the nurse heading toward them. He was moving faster than she had ever seen him move before.
One of the students handed the coach a sweatshirt. “If it’ll not hurt her, maybe you could put this under her head.”
The coach took the sweatshirt and placed it under Laura’s head. Another girl offered a sweatshirt, “Put this over her shoulders to keep her warm, we don’t want her to go into shock.” As the coach covered Laura’s shoulders another girl covered her midsection with another shirt. She realized some of them were listening in First Aid class.
By then the nurse came up, took a look at Laura’s leg and checked her pulse. “Good job covering her, we don’t want her to go into shock. I know this sounds awful but do you hurt anywhere but your right leg?”
“My right arm must be skinned, it burns.”
“You fell on it, I can’t see any significant bleeding so let’s not move you to look until the ambulance gets here.”
“That’s fine by me. I still feel cold.”
With that three more sweatshirts were offered and placed over her.
“Thanks, that’s better, whoever.” From her position on the ground Laura could not see the people who were helping her.
The principal arrived but was waiting for the nurse to make an assessment. “Does she need to go to the hospital?”
The nurse said, “Yes,” and pointed to Laura’s knee. The principal turned green and nodded. He pulled out a paper and handed it to the coach. It was a copy of Laura’s emergency notification form. The coach smiled and said, “Thanks.” She had always looked at this wimpy guy as a marginally useful bureaucrat but today he had been a strict observer of protocol and had done exactly the right thing to make things easier and simpler. She took the paper and bent down to Laura.
“Laura, I need to call someone to have them meet us at the hospital. Who would be best?”
“Dad’s on the road today, you better call mom at work. Her number is 555-2233. Her name is Leah Durin.”
Coach Lackey looked at the number on the form, it was right. She pulled the cell phone off her belt and started to dial as the EMT’s pulled up then clicked it off and put it back on her belt. The ambulance siren indicated it was near too. The coach handed the paper to the principal. “Can you tell her mom what is happening and where to meet us?” He nodded and took out his phone. This was his kind of thing, his area of expertise. Let him do it.
The EMT’s checked Laura and decided to wait for transport to arrive before moving her. Again the girls heard the “Good job” message for keeping the injured girl still and warm.
The ambulance was pulled as close to Laura as possible. They brought the stretcher over and lowered it. The ambulance attendants, the EMT’s, the school nurse and the coach braced Laura’s right leg to the left one and lifted her to the stretcher. They took off the sweatshirts and covered her with two blankets and put her into the ambulance.
By the time they were ready to leave the principal walked over to the ambulance, “Laura, your mom is on her way to the hospital, Mrs. Barton will ride with you. I’ll follow the ambulance in my car to be there if you need anything till your mom comes. That way we have a car so we can come back to school.” Without waiting for anything further he turned and started toward the building. Coach Lackey smiled. This guy was worth something. He turned a little green when he first saw Laura’s leg, but he came through.
At the hospital Laura was taken quickly to a room for evaluation. Her mother arrived while they were getting her settled for treatment. They first x-rayed her leg. Her mother was holding her hand when Dr. Zinne came in.
“You have a broken femur, very near the distal end and it displaced somewhat, that is why your knee looks so out of shape. We need to get the fracture reduced and get your leg into a cast with a couple of pins through the bone to stabilize it. The reduction and pinning will hurt, but once we reduce the fracture and get you into a cast the pain should get more manageable.”
“Go ahead and do it, it hurts.”
“OK, then let’s do it. They thought it was fractured when you came in so they put you in this room so we don’t have to move you. I’ve asked them to bring in a portable x-ray to check the alignment before we put on the cast. When it gets here we start. I’m going to give you a local.”
He took hold of her leg and started to feel over it.
“Let’s get you on your back, I know that is going to hurt some to move, but let me support your leg as you do.” He injected her leg in several spots. There was a noise at the door as he finished. The x-ray was coming in. “OK, let’s roll you over.” She started to move, there was pain, but she bit her lip and moved. His hands were strong. He supported her leg with very little movement.
As she settled on her back she said, “Thanks.”
He looked at her mom, “You can stay, if you do, you stand over at her head and just hold her hands. This is going to hurt pretty bad for a few seconds, but I don’t want to have to put her to sleep for this unless we can’t do it without the anesthesia. If it looks like we can get a closed reduction I usually try once or twice, I usually get a conversion then or I know that I need to do something different.”
“Please do your best, I don’t want the anesthesia unless I absolutely need it.”
“I will.” He turned to the two assistants, “Jill and Margie, you hold her still and on three I will pull it.” The two women moved to positions next to the table and he took Laura’s leg in both hands. “One, two, three.” There was a pop and a lot of pain for an instant then it seemed to subside. He held her leg and looked at it. “Nearly there, this one will not be as bad, on three.”
With the next crack the pain was not as great and her leg was straight.
“Let’s block it and get a picture. Try to not move.”
They blocked her leg and the technician shot an x-ray. He looked at it and smiled. He waited for the local to take effect and inserted three pins. It was strange seeing six ends of the pins sticking out of her leg.
“Let’s get it into a cast, I don’t like playing with perfection. Now don’t move.”
They applied the cast material and soon her leg was covered with the plaster. “I did plaster rather than fiberglass, it’s heavier but it makes a firmer cast. I don’t want any movement. We want that to heal quickly.”
“Me too, I need to get back to the soccer field.”
“Whoa, young lady, not that quick. This will be on for at least five weeks, maybe longer. And you will not be playing soccer the day we take it off or even for a couple weeks after that.”
She wrinkled her nose. “But how soon? I need this season for scholarships.”
“Getting your leg back together comes first. Let’s do that then we get you back on the field. You may be setting out this season.”
“OK, but no longer than necessary.”
“We need pictures of the bone to make sure it is together right before you leave and the gal from PT will come in and fit you for crutches and show you how to use them. We will schedule you for a visit with your orthopedic surgeon in a week. I’ll give your mom some instructions and a prescription for pain, you may need something to sleep for a night or two. Any questions?”
“Why did it break, I have done kicks like that a hundred times? Why now?”
“Don’t know. Must have just been the way you came down on it.”
“Could I do it again?”
“Possibly. Your body doesn’t come with any guarantees.”
“OK, so there isn’t any way of knowing.”
He nodded. “Lay still for a while, when the cast is harder, say about an hour, we’ll get you out of here. Go home get some rest. Let your leg heal. Then we may have a better idea of what happened. I’ll have Radiology look at the x-rays Monday.”
“Thanks, but it scares me, I could get this cast off and break it again the next day.”
“Let’s let your orthopedic surgeon take care of that when you get the cast off.”
Her dad was in the living room when they got home. He hugged her at the door then was at a loss on what to do to help her get to the sofa. Her mom fussed with her, getting her a pillow, a glass of water. It was by now well past noon. “Are you hungry.”
“Just something light, I still feel somewhat queasy.”
“OK. I’ll get something light for us.” She went to the kitchen, after a few seconds she called out, “The doctor said you should elevate your leg as much as possible for a few days to keep it from swelling. Maybe you should get it up now.”
Her dad got up and placed the hassock under her foot. “So, what happened, I just got sketches.”
She explained the events to him. He listened. “So you did a kick and lost your balance?”
“No, I didn’t loose my balance, the leg gave out on me while I was up, I fell because it buckled.”
“Your knee buckled?”
“No, the upper part of my leg, the bone broke while I was running.” Her eyes filled with tears, “Daddy, my leg broke while I was running, I heard it snap, I felt the pain before I fell. I knew it was bad before I hit the ground. Now I’ll not be able to get a Soccer scholarship.”
“Laura, this isn’t going to keep you from the scholarship.”
“I’ll not be able to play this season, I’ll miss the experience and the training, and the scouts will see me as an injury risk.”
“We’ll worry about it when the time comes. If you don’t get the scholarship we’ll find a way to get you to college. We’ve always done what was needed.”
“But this was something I could do. Even if we have the money, there are other things. It will reduce what we can do with Habitat.”
“And if you can do it, you will, if not we work out something else.”
“How are Larry, Lem and I going to get to school, I can’t drive like this?”
“Your mom will take care of it.”
“But she has to be at work before we have to be at school. That was the big thing about me getting my license and the car.”
“It doesn’t matter.”
“It does to me, I agreed to take the guys to school.”
“It was a good idea when we did it. If it is so important to you, maybe we can get a gas pedal on the other side? We’ll see if you can get in the driver’s side of the car tomorrow. Let me see if I can find a left foot pedal.”
“I can get into the driver’s side, I tried it at the hospital and mom had a cow.”
He laughed, “I bet she did.”
“Can you see if you can help me figure out how to get to my computer? I have to get my assignments and get them done.”
“Sure, but wouldn’t it be good to wait?”
“I need to do it now.”
He nodded, like her mother, when she said something had to be done now it had to be done now. “OK, let’s go. Can I help you?”
“Please help me by doing only what I can’t do for myself.”
“OK.”
She picked up her crutches and headed toward her room. She stopped at the door and pushed it open with her left crutch, then crutched over to her computer chair. She pulled it out and lowered herself into it. “I need to figure what to do with this when I am working. It isn’t going to fit under the desk.” She pointed to the cast on her right leg.
“Maybe we can put something to the side for you to put it on, you’ll have to sit sideways with your leg pointing out here.” He pointed to the side. He looked around the room, picked up a chair placed it to the right of her desk. “See if your leg will go in that.”
She lifted her leg and he slid the chair under it. She nodded, “That’ll work. Let me do some of my homework, when mom gets lunch ready ask her if she can bring it in.”
“OK, will do. When you get tired, get some rest.”
“I will. And ask mom to bring in a couple of the pain pills, this is really hurting.”
“OK.”
She booted her computer, downloaded assignments and started working. Her mom brought in the pills and a bowl of soup for her. She fussed over Laura for a while then left as she realized Laura needed some time to work and some time alone.
Both parents checked on her several times during the afternoon. Her dad asked if she could stay there alone for about twenty minutes if he and her mom went to school to pick up her brothers and her car. He handed her the cordless phone. She nodded and went back to typing.
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