{"id":37116,"date":"2021-01-13T10:19:03","date_gmt":"2021-01-13T17:19:03","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=37116"},"modified":"2023-09-28T16:03:07","modified_gmt":"2023-09-28T22:03:07","slug":"limb-lengthening-surgery-after-a-bad-break-of-his-hip","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/limb-lengthening-surgery-after-a-bad-break-of-his-hip\/","title":{"rendered":"Lengthening a limb after a bad break of his hip"},"content":{"rendered":"
<\/div>
\"Wim
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.<\/figcaption><\/figure>\n

It\u2019s not often you manage to damage yourself in a city of 70,000 \u2013 the population of Broomfield or Castle Rock \u2013 that\u2019s also the middle of nowhere.<\/p>\n

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<\/a> 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.<\/p>\n

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\u2019s 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, \u201cOh, honey, you\u2019re doing so great!\u201d<\/p>\n

Whoops<\/strong><\/h2>\n

On cue, he went down \u2013 hard \u2013 on his right hip. The Black Rock desert\u2019s 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: \u201cMan, that was bad.\u201d<\/p>\n

\"Haverhals
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.<\/figcaption><\/figure>\n

Haverhals regrouped for a moment, then went to stand.<\/p>\n

\u201cIt felt like someone had driven a sword into the side of my leg,\u201d he recalled. \u201cI could not walk.\u201d<\/p>\n

With the aid of an old-school glass-plate X-ray machine, volunteer doctors identified a severe break<\/a> of the femoral neck. Haverhals\u2019s Burning Man 2017 experience ended that day, Friday, Sept. 1, in a Cessna medevac.<\/p>\n

Doctors in Reno reconnected the ball joint to the femur with three long screws; Kristi and family, having packed up the camper in Haverhals\u2019s absence, picked him up on Sunday and drove back to Denver. Had the hip healed, this story would be over.<\/p>\n

The hip didn\u2019t 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\u2019t 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<\/a> at UCHealth University of Colorado Hospital<\/a> (UCH) on the Anschutz Medical Campus<\/a>.<\/p>\n

Fix the hip<\/strong><\/h2>\n

Stoneback is the CU School of Medicine\u2019s chief of Orthopedic Trauma and Fracture Surgery and leads UCHealth\u2019s Limb Restoration Program at UCH. He saw a limb that needed restoring.<\/p>\n

\":
Haverhals may have been smiling, but he was seriously hurt just after the tumble. Photo courtesy of Wim Haverhals.<\/figcaption><\/figure>\n

The femoral neck had failed to reconnect to the ball joint \u2013 technically, a nonunion.<\/p>\n

\u201cThat means, if it doesn\u2019t go on to heal, it may need to be replaced, and when you\u2019re an active individual like him, you can\u2019t do all the things you want to do,\u201d Stoneback said.<\/p>\n

For Haverhals, a hip replacement could mean no more CrossFit, no more snowboarding, and no more intense hiking \u2013 all passions.<\/p>\n

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.<\/p>\n

The surgery was a success, and in the weeks that followed, the joint finally healed.<\/p>\n

But Haverhals lost a little more than an inch of bone between the ball joint and the trochanter (what most refer to as our \u201chipbone\u201d). That, in turn, shortened Haverhals\u2019s right leg by more than half an inch.<\/p>\n

The body\u2019s desire for orthopedic symmetry soon became evident. Haverhals\u2019s back started hurting and essentially never quit.<\/p>\n

\u201cWhen you\u2019re not balanced, you\u2019re walking crooked all day long,\u201d explained Stoneback. \u201cIt\u2019s debilitating.\u201d<\/p>\n

Limb-lengthening surgery<\/h2>\n
\"Dr.
Dr. Jason Stoneback performed limb-lengthening surgery for Wim Haverhals.<\/figcaption><\/figure>\n

The answer was to lengthen Haverhals\u2019s femur between hip and knee. That would compensate for the shortened femoral neck and even Haverhals\u2019s 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\u2019s humerus.<\/p>\n

The surgery happened on Nov. 15, 2018. Stoneback first drilled small holes in Haverhals\u2019s 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<\/a>) intact. Doing so essentially invites those live tissues to regenerate what most of us would describe as \u201cbone\u201d but is merely the most obvious element of a complex system.<\/p>\n

\"A
A X-ray of Haverhals\u2019s hip on arrival at UCH. The break wasn\u2019t healing, and the screws were coming loose. Photo courtesy of Jason Stoneback.<\/figcaption><\/figure>\n

Stoneback then drilled a hole into the bottom of the femur at Haverhals\u2019s knee and inserted and anchored a roughly foot-long internal lengthening nail.<\/p>\n

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\u2019s 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 \u201chealed\u201d \u2013 or better, regrown \u2013 in about six months.<\/p>\n

Back to life<\/strong><\/h2>\n
\"an
In May 2020, with the gap in Haverhals\u2019s 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.<\/figcaption><\/figure>\n

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.<\/p>\n

In early December, Haverhals described the limb-lengthening surgery as \u201can incredible procedure,\u201d 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.<\/p>\n

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\u2019ll ask them to airlift him straight to UCH and Stoneback, he says.<\/p>\n

The doctor is happy with the outcome, too. A hip replacement<\/a> would have been easier, but it would have robbed Haverhals of his passions for decades hence.<\/p>\n

\u201cWe got him back to the things he wants to do and restored him to his optimal self,\u201d Stoneback said.<\/p>\n","protected":false},"excerpt":{"rendered":"

It\u2019s not often you manage to damage yourself in a city of 70,000 \u2013 the population of Broomfield or Castle Rock \u2013 that\u2019s 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, […]<\/p>\n","protected":false},"author":23,"featured_media":37117,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[7],"tags":[67,3063,3372,183,9167],"class_list":["post-37116","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-stories","tag-orthopedic-care","tag-orthopedic-joint-replacement-preservation","tag-orthopedic-trauma-and-fracture-surgery","tag-orthopedics","tag-specialized-services"],"acf":[],"yoast_head":"\nLimb-lengthening surgery after a bad break of his hip - 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