Lengthening a limb after a bad break of his hip

A hard fall at Burning Man could have meant a hip replacement – and serious limitations – for outdoorsman
Jan. 13, 2021
Wim Haverhals and wife Kristi on the way up Santa Fe Peak in early December, 2020, limb-lengthening surgery..
Wim Haverhals and wife Kristi on the way up Santa Fe Peak in early December, 2020, after Wim’s limb-lengthening surgery. Photo courtesy of Wim Haverhals.

It’s not often you manage to damage yourself in a city of 70,000 – the population of Broomfield or Castle Rock – that’s also the middle of nowhere.

So it was, though, for Wim Haverhals. During the week leading up to Labor Day 2017, the 50-year-old Denver IT professional was back in Black Rock City, Nevada, for the annual weeklong Burning Man arts and music festival. He and wife Kristi had brought along young-adult offspring for what had become a regular pilgrimage for the Dutch-American and his family.

An administrative to-do which, in a permanent city of 70,000, would involve a few taps on a smartphone now required a commute across the dusty pan to one of two camps with wireless access. Haverhals hopped on a friend’s one-wheeled skateboard to make the trip in style. Despite being new to one-wheeled-skateboarding, Haverhals was an expert snowboarder and all-around athlete. And indeed, he took right to the one-wheeler. As he warmed up prior to the errand, Kristi snapped cell-phone photos and said, “Oh, honey, you’re doing so great!”

Whoops

On cue, he went down – hard – on his right hip. The Black Rock desert’s inch-thick blanket of fine white dust did little to cushion a floor that may as well have been concrete. A guy from the trailer across the temporary street commented: “Man, that was bad.”

Haverhals moments before the fall. He suspects something hard in the black hip pouch focused the impact on his hip.
Haverhals moments before the fall. He suspects something hard in the black hip pouch focused the impact on his hip. Photo courtesy of Wim Haverhals.

Haverhals regrouped for a moment, then went to stand.

“It felt like someone had driven a sword into the side of my leg,” he recalled. “I could not walk.”

With the aid of an old-school glass-plate X-ray machine, volunteer doctors identified a severe break of the femoral neck. Haverhals’s Burning Man 2017 experience ended that day, Friday, Sept. 1, in a Cessna medevac.

Doctors in Reno reconnected the ball joint to the femur with three long screws; Kristi and family, having packed up the camper in Haverhals’s absence, picked him up on Sunday and drove back to Denver. Had the hip healed, this story would be over.

The hip didn’t heal. As fall grayed into winter, Haverhals graduated from walker to crutches to cane but never back to his own two legs. The pain was ceaseless. He couldn’t lie on his right side. The screws in his hip lost their grip and protruded into muscle and tendons. Finally, in January 2018, Haverhals found his way to Dr. Jason Stoneback at UCHealth University of Colorado Hospital (UCH) on the Anschutz Medical Campus.

Fix the hip

Stoneback is the CU School of Medicine’s chief of Orthopedic Trauma and Fracture Surgery and leads UCHealth’s Limb Restoration Program at UCH. He saw a limb that needed restoring.

: Haverhals may have been smiling, but he was seriously hurt just after the tumble.
Haverhals may have been smiling, but he was seriously hurt just after the tumble. Photo courtesy of Wim Haverhals.

The femoral neck had failed to reconnect to the ball joint – technically, a nonunion.

“That means, if it doesn’t go on to heal, it may need to be replaced, and when you’re an active individual like him, you can’t do all the things you want to do,” Stoneback said.

For Haverhals, a hip replacement could mean no more CrossFit, no more snowboarding, and no more intense hiking – all passions.

To fix the hip, Stoneback performed an intertrochanteric osteotomy and femur nonunion repair. In other words, he pulled the screws, made a carefully calculated cut of the bone below the unhealed break, realigned the hip based on careful geometric planning, and affixed a blade plate to hold the new connection together.

The surgery was a success, and in the weeks that followed, the joint finally healed.

But Haverhals lost a little more than an inch of bone between the ball joint and the trochanter (what most refer to as our “hipbone”). That, in turn, shortened Haverhals’s right leg by more than half an inch.

The body’s desire for orthopedic symmetry soon became evident. Haverhals’s back started hurting and essentially never quit.

“When you’re not balanced, you’re walking crooked all day long,” explained Stoneback. “It’s debilitating.”

Limb-lengthening surgery

Dr. Jason Stoneback who performed the limb-lengthening surgery.
Dr. Jason Stoneback performed limb-lengthening surgery for Wim Haverhals.

The answer was to lengthen Haverhals’s femur between hip and knee. That would compensate for the shortened femoral neck and even Haverhals’s legs out again. Stoneback performs perhaps two dozen limb-lengthening surgeries a year, on bones including the femur, the tibia and fibula in the lower leg, and the upper arm’s humerus.

The surgery happened on Nov. 15, 2018. Stoneback first drilled small holes in Haverhals’s femur at mid-thigh. Then, through a procedure called a corticotomy, he carefully cracked the femur in a way that left the live tissues inside the bone (medullary vessels) as well as the skin-like web of tissues coating the bone (the periosteum) intact. Doing so essentially invites those live tissues to regenerate what most of us would describe as “bone” but is merely the most obvious element of a complex system.

A X-ray of Haverhals’s hip on arrival at UCH that shows how the break wasn't healing and screws painful. It is the reason why a limb-lengthening surgery was needed.
A X-ray of Haverhals’s hip on arrival at UCH. The break wasn’t healing, and the screws were coming loose. Photo courtesy of Jason Stoneback.

Stoneback then drilled a hole into the bottom of the femur at Haverhals’s knee and inserted and anchored a roughly foot-long internal lengthening nail.

The name belies its complexity. An internal lengthening nail contains gears and a magnet. For about a month following surgery, Haverhals placed a magnetic controller on his thigh three times a day; each time, the nail’s gears turned enough to add one-third of a millimeter to the length of his femur. The live tissue Stoneback left in place started regenerating bone and continued to do so for months after the desired length was reached. The bone was completely “healed” – or better, regrown – in about six months.

Back to life

an x-ray showing how limb-lengthening surgery helped fill the gab in this man's hip.
In May 2020, with the gap in Haverhals’s femur long since filled in by way of limb-lengthening surgery, Stoneback removed the internal lengthening nail. The hardware from the initial repair can stay in place. Photo courtesy of Jason Stoneback.

Along the way, Haverhals did physical therapy to adapt the muscles and tendons stretched out during that process. By November 2019, Stoneback gave Haverhals his blessing to snowboard again, and the patient rode all season. In May 2020, Stoneback removed the lengthening nail; Haverhals was back doing CrossFit within a month.

In early December, Haverhals described the limb-lengthening surgery as “an incredible procedure,” if a painful one. He had, a couple of days earlier, snowshoed up 12 miles up Santa Fe Peak in Summit County and snowboarded back down.

Burning Man is back on his radar even if one-wheeling around the desert may not be. Should Haverhals end up in a similar situation, God forbid, he’ll ask them to airlift him straight to UCH and Stoneback, he says.

The doctor is happy with the outcome, too. A hip replacement would have been easier, but it would have robbed Haverhals of his passions for decades hence.

“We got him back to the things he wants to do and restored him to his optimal self,” Stoneback said.

About the author

Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado, where he was a Ted Scripps Fellowship recipient in Environmental Journalism. He is author of “A Beard Cut Short,” a biography of a remarkable professor; “The Laser That’s Changing the World,” a history of lidar; and “From Jars to the Stars,” a history of Ball Aerospace.

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