Ken McDonnell is a husband, a father and a triathlete. In fact, he had just completed a triathlon – a three-hour race consisting of back-to-back legs of swim, bicycle and run – a couple weeks before he hopped on his mountain bike to ride the trails near his home in central Massachusetts. It was a crisp fall afternoon, and normally he would be training on his road bike, but that October day, McDonnell decided to take a more leisurely ride in Rutland State Park. He spent most of the time that day on trails or park roads with barely anyone around. He completed one section of the trails and then got on Route 122, a two-lane highway that runs outside the park, for a short ride to another section of trail.
What happened next? McDonnell has no recollection. According to an eyewitness, a car travelling about 50 mph veered into the breakdown lane in which Ken was traveling, striking him from behind. “I was thrown up onto the car’s windshield and into the air before smashing onto the pavement,” says McDonnell. “My bike landed across the guardrail in the woods and was destroyed. My helmet was broken in half. I’ve often wondered whether I sensed the impact as it was happening.”
He was transported via critical care air transport to a local trauma center, where he remained in a coma for more than three weeks. “Due to the traumatic nature of the accident, I have no recollection of that time,” Ken says. “I had no realization of the severity of my injuries until after I woke up, five weeks later, or that I was given a 25 percent chance of surviving the first night.”
McDonnell had suffered grave injuries – a fractured skull and traumatic brain injury (TBI), a severe pelvic fracture, multiple cracked vertebrae and broken ribs, massive internal bleeding, a renal artery aneurysm and a collapsed lung. While he lay in a coma, his wife Deborah was keeping family and friends around the country updated about Ken’s condition. One of those people was a close friend, an orthopaedic surgeon in California. “Coincidentally,” Ken says, “this friend was arriving in Boston the next day to attend a conference. When she landed, she came directly to the hospital.”
After viewing the X-rays and realizing the severity of the pelvic injuries, she offered to discuss the situation with Paul Tornetta, MD, FACS, FAAOS, Professor and Vice Chairman, Department of Orthopaedic Surgery, Boston University School of Medicine and the Director of Orthopaedic Trauma for Boston Medical Center. Tornetta was scheduled to present at the conference she was attending. Well aware of his outstanding reputation nationally, Deborah and her friend hoped Dr. Tornetta would be willing to treat Ken. They connected at the conference and after reviewing the X-rays, Tornetta agreed that the injuries warranted moving McDonnell to BMC for treatment.
The decision to have Ken transferred to BMC from the initial hospital was an agonizing decision for Deborah, particularly since he was comatose and breathing on a ventilator, which makes transporting a patient exceedingly more dangerous. Tornetta kept in frequent touch with Deborah during this critical time. When Ken’s respiration had improved enough to move him, he was transported by critical care ambulance to BMC, an ICU nurse travelling alongside him to make sure his life support measures were maintained.
Upon arrival to BMC, Deborah met with Dr. Tornetta, who laid out the options and plan to fix Ken’s injuries.
“Mr. McDonnell’s pelvic injury was severe”, says Tornetta. “He had a complete separation of one hemipelvis from the other, including a symphysis dislocation and a sacroiliac joint fracture dislocation.” This means that the sacrum – a large, triangular bone at the base of the spine between the two hip bones – was fractured and a portion of the sacroiliac joint – which connects the sacrum with the pelvis – was dislocated.
While at the initial hospital, an external fixator had been placed to stabilize the displaced pelvis. Dr. Tornetta’s plan was to remove the external fixator and temporize the pelvis in traction, and then perform a definitive internal fixation of the pelvis. “This involves an incision in the front of the pelvis and retraction of the bladder to access the symphysis and reduce the dislocation,” says Tornetta. “This reduction (setting of bones), now several weeks after Mr. McDonell’s injury, can be difficult and time consuming, and must be precise in order to allow the best chances of a positive result. Fortunately, we were able to achieve a very good reduction of the symphysis, which helped to line up the back part of the pelvis.”
Options for the treatment of the posterior pelvic injury range from an open reduction (using an incision to access the joint and place hardware to reduce the displacement) to a percutaneous technique (placing screws into the bone from just below the skin). This decision is driven by how close the bones move to their normal position after the front part is aligned. In McDonnell’s case, Dr. Tornetta was able to shift the bones enough that he could perform a careful percutaneous procedure on the back part of the pelvis. “With special X-ray guidance, we were able to place screws perpendicular to the displacement, and these screws were used to tighten the fractured part back to its normal position,” says Tornetta. “Neurologic injury is possible during these technically difficult operations, and the radiographic analysis in the operating room along with the precision placement of the screw is paramount in avoiding this complication.”
“This injury presented a real challenge in Mr. McDonnell getting back to his pre-injury function as a triathlete,” says Tornetta. “Unfortunately, most patients will not be able to regain that heightened level of activity, and without essentially perfect alignment, that chance is greatly diminished. We have treated several triathletes and marathoners who have gotten back to that level. The job we do in the operating room – restoring the anatomy – is the first step in trying to restore function.”
McDonnell spent three weeks at Boston Medical Center, including time in the Surgical Intensive Care Unit (SICU). “Deborah and I could not have been better served at BMC,” he says. “The obvious evidence is that I have recovered nearly 100 percent to my pre-injury physical abilities.” In fact, McDonnell was able to return to triathlon training within six months of the injury, and he completed his first post-injury race less than a year after the injury. “I attribute this largely to the care I received at BMC, with the surgery by Dr. Tornetta obviously the most crucial factor.”
Deborah adds, “Dr. Tornetta brought not only technical excellence to Ken’s treatment, but he also remained accessible virtually night and day to answer my questions and concerns. He maintained this level of extraordinary care through Ken’s treatment and rehabilitation.”
Now Ken has more than 30 triathlons under his belt – seven races since the injury – culminating this past summer with his completion of Escape from Alcatraz, a grueling triathlon whose course consists of a one-and-a-half mile swim starting near Alcatraz Island, an eighteen mile bike ride, and an eight-mile run.
Perhaps the physical prowess and that grit, the never-give-up mentality that a triathlete holds deep within to finish such punishing races helped McDonnell on his road to recovery. “Never during my recovery did it even occur to me that I might not recover fully,” say McDonnell. “This may have been a naïve attitude, since I could easily have ended up severely disabled if not dead.” McDonnell considers himself fortunate on many levels. “I certainly benefited from my wife’s lifelong friendship with her friend, who referred me to Dr. Tornetta,” he says. “I consider him to be a miracle worker, a sentiment reinforced by my primary care physician and therapists, and by friends in the field of medicine.”