Daniel Rioux was walking back to his office after a workout out like he had so many times before when a 20,000 pound scaffolding platform at a Boston construction site came crashing fifteen stories down. Three people including two construction workers and a local physician also passing by died that April afternoon, but Daniel survived. “I was struck in the lower right leg by a large piece of metal,” says Rioux. “It shattered my bone and it was sticking out. A dead body lay a few feet away from me. I was the sole survivor of the incident and am lucky to be here today.”
When Rioux realized the severity of his injuries, he began screaming for help. “I assumed that I was going to lose part of my leg and actually visualized myself with a prosthetic,” says Rioux. He was rushed to Boston Medical Center, fortunate to be alive but with substantial leg injuries. His right tibia and fibula – the lower leg bones – were fractured and open, meaning the bone had pushed out through the skin.
Upon arrival to BMC’s Trauma Center, Rioux met Paul Tornetta, MD, FACS, FAOOS, Professor and Vice Chairman, Department of Orthopaedic Surgery, Boston University School of Medicine and the Director of Orthopaedic Trauma for Boston Medical Center. Dr. Tornetta laid out many options for Rioux including: amputation; bone transport, a technique where bone tissue is regenerated within a patients extremity; bone graft, where bone is taken from the patient’s own healthy bone (autograft) or from frozen, donated bone (allograft); or having a permanently shorter leg.
“Mr. Rioux had a severe open tibia fracture,” say Tornetta. “While there are many options for treatment, the primary initial goal is to decrease the risk of infection by performing a thorough cleaning of the bone surfaces, stabilizing the bone, and then obtaining coverage over the bone with healthy soft tissues.”After weighing the various options, they decided to create a treatment plan to save Rioux’s leg. “We use the term ‘limb salvage’ to describe the decision and process to save the leg rather than do an early amputation,” says Tornetta. “Many times difficult decisions need to be made and our job is to provide information to the patient and help them make choices about their treatment plan which makes the most sense for them.”
“I was very happy with the care I received from Dr. Tornetta,” says Rioux. “There were painful and difficult decisions that had to be made, but he and his team were very helpful in clearly laying out the options and providing information and about each one.”
Rioux’s road to recovery has been long and arduous; including an initial month long hospital stay, as well as numerous one to two week planned and staged admissions for complex repairs. In all, Rioux had 12 surgical procedures, including application of an external fixator, where pins are inserted through the skin into the bone and held in place by an external frame allowing proper alignment of the bones.
This procedure is commonly used for severe open fractures and allows for management of soft tissue injuries and for easier access into the affected area for cleaning. In fact, despite the best treatment options, the infection rate for such severe injuries is still in the range of 20 percent and that is why some surgeons recommend early amputation.
Following the initial internal fixator procedure, Rioux needed revisions of the external fixation to adjust alignment, a pivot of his soleus muscle, where the calf muscle is shifted around the tibia bone and a skin graft, a procedure where skin from his thigh was transferred to cover the portion of skin where the bone had come through his leg.
“Several recent studies demonstrate that nearly 100 percent of patients will have significant deficits after such injuries,” says Tornetta. “Our goal is always to support the patients’ return to as close to normal function as possible”.
Today Rioux is back to working out three times a week and even coaches his son’s Little League baseball team where he is on the field and pitches to the kids. “I also plan to play golf again,” says Rioux. “I have hit balls at the range and it will be interesting to see how I do on the course!” Also, this past Father’s Day, his wife gave him a new bicycle. Returning back to normal physical shape is also important for Rioux’s work, where travel is essential to maintaining and building business. Most importantly though, Rioux is once again able to keep up with his wife and kids – “I am able to do a lot with them now that I wasn’t able to do for a long while,” he says.