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Susan’s story: Orthopedic rescue following traumatic vacation fracture.


While Susan DeMarco enjoyed her solo vacations in Curacao, an idyllic Dutch Caribbean island known for its tropical beaches, she was excited that her grown children and their significant others would be joining her this year. “We hadn’t been away on a family vacation for many years,” said Susan of her daughter and son-in-law Suzanna and Billy Clark and her son Clay DeMarco and his girlfriend Jenna.

ATV adventure gone awry

The adventurous group set off on an ATV (all-terrain vehicle) tour advertised as an easy way to see the island. In retrospect, Suzanna says she wished she’d paid more attention to the lack of instruction provided by the tour guides. “Basically, they said “here’s the gas and here’s the brake,” and off we went,” she said.

Her mom, Susan, athletic and confident at 64, was astride a single ATV behind the tour guide. Soon into the journey, the dusty terrain became rugged, surrounded by jagged volcanic rocks. “It was far more treacherous than I expected,” Susan recalled. When two experienced ATVers in the group sped past Susan, she became distracted. “I took my eye off the trail and found myself heading straight up a ten-foot rock. I let go of the throttle, my ATV did a “wheelie” and I was ejected. I knew immediately that my leg was broken. The pain was excruciating.”

Suzanna leaped off her ATV and rushed to her mother’s side. “Billy is calm by nature and an EMT by training,” she said. “He stabilized her leg but we could tell my mom’s knee was dislocated.” Though in a state of shock, the family sprang into action. They formed a human shield around Susan in the intense mid-day sun as they waited for an ambulance. Once at the hospital in Willemstad, where little English was spoken, they waited several hours more for an X-ray.

Susan demarco and her daughterLong-distance orthopedic expertise

Suzanna, a former employee at Tufts Medical Center, knew instinctively that her mother needed the expertise of one of their orthopaedic trauma surgeons. Scott Ryan, MD, Chief of Orthopedic Trauma, took her call and became the family’s medical guide from a far. He reviewed the X-rays and confirmed that Susan had a tibial plateau fracture/dislocation of her left leg.

With guidance from Dr. Ryan and the help of a translator, Suzanna made sure her mother’s plaster cast allowed room for swelling prior to boarding their flight back to the United States the next morning. “Susan was at risk for developing compartment syndrome which can decrease blood flow to the leg and change the urgency of the initial surgery,” said Dr. Ryan.

Happy to be back at Tufts MC

After a difficult flight – including a connection in Miami – the family landed in Boston at 3:00 p.m. Natalia Santana, Administrative Assistant to Dr. Ryan, arranged for an ambulance to meet them at their gate at Logan Airport where they were immediately transported to the Tufts Medical Center Emergency Room (ER). “Billy and I hadn’t slept for two days so I was feeling foggy,” admitted Suzanna. “I just knew I was happy to be back in Boston and at Tufts.”

Susan demarco after surgeryDr. Ryan and his team did an initial assessment of Susan in the ER and began her surgery at 6:00 p.m. “I knew I was in excellent hands when I met Dr. Ryan, his residents and the anesthesiologist,” said Susan. “I like to be informed and they did an incredible job explaining the situation, its severity and what the plan of action would be.”

That evening, Dr. Ryan stabilized Susan’s damaged leg by putting pins above and below the break in the femur bone and the tibia bone and then connecting bars to the pins. “We pulled on the leg to straighten it and then tightened the pin/bar construct – known as a fixator – to get the leg in an acceptable position for the next surgery,” said Dr. Ryan. Susan spent the weekend at Tufts MC and had her final surgery on Monday. “This surgery involved removing the fixator and putting plates and screws on the breaks for the inside and outside parts of the tibia bone at the level of the knee,” said Dr. Ryan.

Susan demarco at homeLong rehabilitation road

Susan relied on Dr. Ryan’s expertise and perspective as she began the long rehabilitation process of intense physical and occupational therapy, first as an inpatient at a rehabilitation facility and now back home in Hampton, NH. Though Susan works in the healthcare field as director of organizational development at Exeter Hospital, she has never experienced a serious health issue until the accident. “I’m very active. I ski, kayak and bike. It has been hard to be sedentary. I’m grateful to be alive and am committed to doing the work to reclaim my life,” said Susan.

Susan visits Dr. Ryan’s outpatient Orthopaedic Clinic regularly. “We X-ray her leg to make sure it is healing well. We look at her incisions and test her knee’s range of motion. Overall, Susan’s functional recovery is excellent. My expectation is that she will get back to all the activities she enjoys,” said Dr. Ryan.

Expertise, artistry and teamwork

Susan is effusive when she speaks about Dr. Ryan and his skills. “He is a master craftsman, a true artist,” she said of his surgical work. “He rebuilt my tibia to near perfection and I will be eternally grateful for his expertise, his compassion and his encouragement.”

As Susan looks back on her family vacation, though it didn’t turn out as expected, she is glad her kids came along for the adventure. The DeMarco family certainly learned the value of teamwork – in Curacao and at Tufts MC.

For Susan, she knows one certainty: “I don’t know what I would’ve done without my daughter and I don’t know what she would’ve done without Dr. Ryan.”

Susan's injured leg before surgery Susan's leg after surgery