On April 15 of 2013, Tufts Medical Center’s Chief of Orthopedic Trauma Scott Ryan, MD rushed to the Emergency Department when he received word of the Boston Marathon bombing.
There, injured patients were being brought in and systematically evaluated by a trauma surgeon in one of three trauma bays. Once patients were assessed and x-rays taken, Dr. Ryan and five other orthopedic surgeons took over the care of those with significant lower leg injuries. Altogether, 23 bombing victims came through Tufts Medical Center’s ER.
“With the x-rays coming back, we could see who had soft-tissue or bony injuries,” Dr. Ryan says. “Patients were assigned to us based on our areas of expertise. Since I do trauma and the patient with the worst of the bony injuries became my patient.”
Beth Roche, 60, had traveled from Indiana to watch her daughter Rebecca run her first Boston Marathon. She saw Rebecca cross the finish line from in front of Marathon Sports on Boylston Street just minutes before the bombs exploded. Roche fell to the sidewalk and remembers looking down and seeing bone sticking out of her knee.
“It didn’t hurt much because I was in shock,” she says. “As I was lying there, a man leaned over me and said he’d protect me, and I felt I was going to be OK. I got the same feeling when I met Dr. Ryan, who came up to me in the ER and said ‘I’m an orthopedic surgeon and I’ll take care of you.’ I knew he would. I just felt I was in good hands and could let go; that whatever happens, happens.”
Saving her leg
What happened was that Dr. Ryan spent nearly four hours in the OR cleaning debris out of Roche’s wound – some of which included fragments of black canvas that he later realized were likely pieces of the backpack that held one of the two bombs. And then he began reconstructing her kneecap and stabilizing the bones with titanium rods and screws. He never doubted that he could save Roche’s leg because, fortunately, blood flow to the extremity wasn’t compromised.
“I woke up with a halo apparatus on my leg with four screws into the bone, and I was on enough meds that it didn’t hurt too badly,” Roche says. Dr. Ryan explained what he’d done, and why she’d need a second operation in a few weeks.
As a result of her injury, Roche had lost part of her patella tendon, which attached her kneecap to her lower leg. In the first operation, Dr. Ryan had attached what was left of the tendon to Roche’s kneecap, but once it healed, it would be too tight for her to bend her knee. The second procedure, which would entail reconstructing her patella tendon using her hamstrings, would give her more range of motion. Dr. Ryan performed this second surgery on May 10, assisted by Tyler Skaife, MD, an orthopedic surgeon fellowship-trained in sports medicine.
Ambition helps rehabilitation
After each surgery, Roche spent time at Spaulding Rehabilitation Hospital where she began what will be a year-long physical therapy regimen to help her regain her leg strength and range of motion. About three weeks after her second surgery, Roche returned home to Indiana where she continues with physical therapy three times a week.
“After my second surgery, Dr. Ryan told me he was able to bend my knee 90 degrees during the procedure, which means I should be able to eventually do that myself,” she relates. “Within the first week of PT at home, I’d gained 21 degrees and [as of late August] I’m up to 55 degrees. I’m a fighter, and I’ll do whatever I need to do to get back.”
The reality now is that her leg is a “log” every morning, Roche says. She sleeps with ice on it and must position it a certain way during sleep. But it is getting easier and easier, she stresses. She manages the 29 steps in her house multiple times a day without braces, a walker or crutches. Her pain level – once excruciating – has become much more manageable. And she’s back to work – nearly full time – as an office manager for an ear, nose and throat practice. “I have pain daily which is hard, but I face each day with a positive attitude. Ice is still my best friend,” she says.
Dr. Ryan’s goal for Roche is for her to achieve enough motion in her knee to sit comfortably and fully straighten her knee to walk. “I’d consider that a win,” he says. He also notes that Roche’s risk of arthritis is low because all the cartilage in her knee looks good, so a joint replacement “is not on the radar.”
Roche has ambitious goals for herself.
“I did a marathon last October, and my goal is to do it again,” she says. “And when I’ve run my run, Dr. Ryan will be at the top of the list of people I have to thank for it.”
“While I didn’t promise her she would, Beth certainly has enough motivation to get back to that, and I wouldn’t be surprised if she did,” Dr. Ryan says.
Roche also gives high marks to everyone at Tufts Medical Center involved in her care, including the nurses, aides and other staff who brought her coffee every morning, helped her wash her hair, or simply checked in on her to see how she was doing. She is especially grateful that her daughter Rebecca – a pharmacist who had worked at Tufts Medical Center for six years – was by her side when she woke up from her first surgery. Because she still has friends at the Medical Center, Rebecca was able to locate her mother and rush to be with her.
“It was a family, a network of beautiful people who worked together,” she says, referring to the teams at both Tufts Medical Center and Spaulding Rehab. “They were there for me when I was at my lowest, and they helped to bring me back up.”