A Worksite Fall and the Long Path to Recovery
BMC neurosurgeon, orthopaedic trauma and critical care team get a roofer back on his feet after a devastating worksite fall.
It was a cold and breezy December day when Arthur McGuire, an experienced roofer, and foreman at a Wilmington Mass., construction site, lent a hand to his crew. Moments later his world would literally be turned upside down.
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“I was stepping backwards with some equipment when I lost my footing and fell off of the roof”, says McGuire. “For the first five feet of the fall, I tried grabbing at the brick or anything that I could catch myself on. When I realized I was going down, that’s when my skydiving training kicked in.” An experienced skydiver, McGuire went into a safety technique called Parachute Landing Fall or PLF—a technique commonly used by skydivers or paratroopers during hard landings to avert injury. “I kept my eyes on the horizon, chin tucked and elbows to the side, preparing to roll my body as soon as my feet hit,” he says. “As I landed, I used the force to roll and as I rolled, I could hear bones breaking.” McGuire had fallen from 40 feet. “Next thing I know I am on the ground in the fetal position and could hear someone yelling to call 911”, he says. “I looked to my side and my wrist bone was sticking out.”
As the first-responders arrived, Arthur lay on the ground unable to feel anything for what felt like an eternity. “I thought I was paralyzed”, says McGuire. “It was not until the paramedics started cutting off my clothes and moving me onto the stretcher that I began to experience excruciating pain. It was then I realized I probably wasn’t paralyzed and oddly enough the pain was comforting.”
As the first-responders attended to McGuire, a Boston MedFlight helicopter was en route to bring him to the trauma center at Boston Medical Center (BMC). “I love roofing, I love climbing, my specialty is in complex slate steeple work on churches but I also did a lot of work on the high-rises in Boston,” says McGuire. “One of those sites was another hospital where the helicopter landed on the roof. We would have to stop the work and leave the site when they were landing, and I always thought to myself ‘that person must be in pretty bad shape to come in the helicopter’ and now here I was being loaded into MedFlight on my way to Boston.”
McGuire arrived at Boston Medical Center and immediately was brought into the trauma bay. “It was very impressive,” says McGuire. “As soon as I landed there was a team of doctors and nurses going over me from head to toe.”
McGuire sustained very serious injuries. “He had a lumbar spine burst fracture with retropulsion,” says Justin L. Massengale, MD, Neurosurgeon at Boston Medical Center and Assistant Professor of Neurosurgery at Boston University School of Medicine. McGuire had broken one of the bones of the spine in his lower back (the lumbar spine) at the time of his fall. The bone was crushed (burst) in such a way that a broken piece was pushed into the spinal canal (retropulsion) just above where the spinal cord ends. In addition to the spinal fracture, McGuire also fractured his femur, his wrist and sustained spinal epidural hematoma. “This means that some of the veins that run between the bone and spinal cord where torn by the fractured bone pieces,” says Massengale. “These veins released blood into the space between the bone and spinal cord—the epidural space— that formed a clot, adding to the pressure on the spinal cord and nerves that the bone pieces were already causing.”
The fracture and blood clot were serious enough that Dr. Massengale was concerned that if McGuire were allowed to try to walk in his condition, the fractured bone might break further or the blood clot might grow larger, causing worse pressure on the spinal cord or nerve roots, which could cause problems with their function or even paralysis. “The treatment options included use of a back brace to try to keep his back alignment straight while the fracture healed by itself, which could take months and which could provide him no guarantee that the fracture might still get worse during that time despite the brace,” says Massengale. The other option was an operation to stabilize the spine on the inside with screws and rods, remove the blood clot directly, and reconstruct the broken bone. “This option would provide him the best chance of recovery and prevention of future neurological damage,” says Massengale.
“Dr. Massengale is a saint,” says McGuire. “He came in and sat right down with me and my wife. He told me exactly what was wrong with my spine, what he was planning on doing, what the risks were and how he was going to fix it. And he did just was he said.”
They opted for surgical intervention and the surgical treatment for the spine was divided into two stages. First, an operation was performed through an incision in McGuire’s back to eliminate the pressure on the spinal cord by removing the parts of the bone overlying the blood clot, as well as the blood clot itself. The torn covering of the spinal cord and nerve roots was also repaired at that time, and screws and rods were placed in the normal bones above and below the broken one so that the alignment of the spine would be corrected and held in place (stabilized) while the rest of the surgical treatment and recovery could occur safely.
The second stage of the spine operation was performed through an incision in McGuire’s side. The pieces of the front part of the bone that were causing the greatest amount of compression on McGuire’s spinal cord were removed this way, and replaced with a barrel shaped cage to restore the support that the broken bone could no longer provide. “We were able to perform this portion of the operation with minimally invasive techniques,” says Massengale.
Although the reconstruction of the spine by implanting a titanium cage from the lateral (side) approach are standard for spine surgeons treating this kind of condition, Dr. Massengale and his team in the neurosurgery department at BMC are currently the only practice in the area where a multistage reconstruction operation like Maguire’s is being performed in its entirety with minimally invasive techniques. According to Massengale, “a patient who undergoes this procedure with minimally invasive techniques can achieve the same result with a much smaller incision, less blood loss, and lower risk of infection than the traditional approach.”
McGuire had four major operations in just five days. “The staff was amazing,” says McGuire. “They kept me very comfortable. Before my last operation, I actually got nervous, but one of nurses came over and held my hand. She and the entire staff kept me very calm in what was a very difficult situation.”
The surgery was a success but McGuire’s road to recovery was just beginning. He spent nearly two weeks in the Surgical Intensive Care Unit (SICU). “They treated me like a king,” says McGuire. “The communication was top-notch; the staff explained everything to me and my family. My wife and three daughters were able to spend a lot of time with me in my room and the whole family was treated like royalty.” According to Massengale, “Coordination of care between the multiple surgical and critical care teams, as well as availability of the most state-of-the-art surgical treatment tools, are very important to achieving the goal of providing the best care for patients with serious traumatic injuries like Mr. McGuire’s.”
This experience certainly has changed McGuire’s outlook on life. “You have to enjoy every minute”, says McGuire. “It can end without warning and I value every day. I cannot say enough about the staff at BMC. Knowing I was in their hands during the worst experience of my life and how they went out of their way to make me and my family feel at home during such a tough experience is special.”
It has been a year since the accident and McGuire has been getting stronger every day. He has participated in extensive rehabilitation and according to Massengale, “He has done very well thus far in his recovery process.” In fact, he is now able to hold his first grandchild. “I am looking forward to taking walks on the beach soon with my wife, three daughters and grandson,” says McGuire.