Advanced Procedure Saves Limbs and Lives
Front: Dr. Shannon with Simon, his family
and trauma team members.
“A seven-year-old, with almost four inches of bone missing from his leg, was my very first consult at Bryan, and it was probably one of the worst cases I’ll see in my career,” says Steven Shannon, MD, an orthopedic trauma surgeon at Bryan Trauma, which is part of the Bryan Physician Network.
In the summer of 2019, young Simon Matveyuk was on an American vacation with the rest of his Russian family when a car crash put him and his brother Timothy in the intensive care unit. Timothy was unconscious for nine days with a head wound and broken leg and pelvis, and Simon’s fracture was so severe they thought he might lose his right leg.
“It was more than just a broken tibia,” says Simon’s father, Paul. “There was a hole in his leg. He was missing muscle, skin. The procedure Dr. Shannon offered was the last option.”
Special training put to use
Dr. Shannon was fresh from a fellowship in orthopedic trauma at the world-renowned R. Adams Cowley Shock Trauma Center in Baltimore.
There he gained experience in a rare technique called distraction osteogenesis. The procedure helps regrow bone using a spatial frame with pins outside the body. The surgeon cuts the bone above the injury to create a growth edge and uses the pins to move the healthy bone one millimeter a day.
“It’s essentially growing entirely new bone,” Dr. Shannon says. “It takes time and compliance and several surgeries, but it’s the gold standard for extremely traumatic bone loss.”
Paul and his family were overjoyed to have a solution for Simon.
“They said this doctor started on Monday, and he’s ready to take your child and do a treatment if you want to talk to him. We said of course. We’re going to do that. That’s what we’ve been waiting for,” Paul remembers.
Because of Simon’s infection, Dr. Shannon started the treatment with another unusual procedure called the Masquelet technique, where special, antibiotic-infused cement fills the bone defect.
“It’s like a super strong mixture of antibiotics. — you simply can’t get that high of a dose through an I.V.,” he notes. “After about three weeks, a membrane forms like a tunnel. We come back in through surgery to remove the cement and fill the space with antibiotic beads that gradually dissolve, and we apply the spatial frame at that time.”
Slow but steady progress
At only one millimeter a day, it took months for Simon’s bone to grow back in the spatial frame. Timothy had long since recovered, so the family decided to return home for Christmas and get Simon’s last surgery in St. Petersburg.
“When the two bone fragments finally meet, they’re fibrous and have trouble joining on their own,” Dr. Shannon says. “We perform a final surgery to create a bleeding edge on both pieces that allows them to come together.”
After almost a year of surgeries and treatments, Simon’s spatial frame came off in June.
“He walked maybe a month with crutches, and then he threw them away,” Paul says. “We were visiting friends, and when we came back, he was walking by himself. Great news for us.”
In the year since his first case with Simon, Dr. Shannon performed distraction osteogenesis on six more patients. Before he joined Bryan, those patients’ closest option for the procedure would have been 400 miles away at the Mayo Clinic in Minnesota, where Dr. Shannon completed his residency.
He came to Bryan to fill that need, but admits he didn’t anticipate he would be employing distraction osteogenesis this frequently.
“Orthopedic trauma procedures like this are very specialized and rare,” Dr. Shannon says. “It’s hard to get enough experience to be fully trained on them outside the major trauma centers.”
Orthopedic surgeons typically repair fractures with missing or irreparable bone using either bone grafts or by inserting a steel rod through the bone. Both procedures have limited efficacy for large defects though, and the infection rate is high. One of Dr. Shannon’s other patients, Wayne Brabec of Shelby, underwent the distraction orthogenesis after a failed rod placement.
Spatial frame to the rescue
“In September 2018, I got my lower left leg caught in a wheel while riding on an antique tractor. They put a rod in, but it never did grow back right. I kept getting infections,” Wayne says.
By February of 2020, Wayne’s infection was so severe he was hospitalized for three days. Dr. Shannon performed surgery to take out Wayne’s rod along with several inches of infected bone and place the antibiotic cement. He put the spatial frame on Wayne two weeks later.
“After about June or July I could really feel a difference,” Wayne says. “With the rod I had been eating so much ibuprofen it gave me a bleeding ulcer. But I don’t need to take anything for pain with the frame. I can stand there and even stomp on it, and I can’t feel it.”
Wayne notes that initially the spatial frame was painful, but after 18 months of struggle with the rod, it seems reasonable.
“You gotta be willing to go through the long haul,” Wayne says. “It’s not a quick fix, but it’s the right fix.”
Good reason for hope
Wesley White of Beatrice, another of Dr. Shannon’s patients, had a similar struggle with infection before starting his distraction osteogenesis. His compound fracture from an ATV crash was so drastic that Bryan doctors put him in a medically induced coma for three days while they performed multiple initial surgeries to debride and set pins in the bones.
“Two weeks later I found out that I had an infection in my leg. It was my choice to pick the frame or amputate it,” Wesley says. “I was in so much pain. I honestly considered the amputation. I was afraid of how bad the frame might be, and I just wanted to get it over with.”
Wesley says that the spatial frame was not easy, but he often put on a brave face because he knew he would see young Simon in the waiting room.
“He’s so little. The first day we met he was a little shy. He didn’t really want to show anything off,” Wesley says. “When he saw me walk in with a smile, he’d have a little hope.”
With Simon, Wayne, Wesley and several others walking on legs that they might have lost had their injuries occurred just a year earlier, before Dr. Shannon joined Bryan, there’s good reason for hope.