Ken Pierce rode his motorcycle down a country road early one September morning, keeping a sharp eye out for deer.
But there was no avoiding the one that charged in from the side of the road.
“I got T-boned by the deer,” he said.
The blow knocked him off the road, broke his collarbone and fractured 10 ribs.
Pierce, a 68-year-old retired pharmacist, had been on his way to a golf course. Suddenly, driving one down the middle of the fairway didn’t seem so important.
The fractures that littered the left side of his rib cage made every breath painful.
A broken rib can cause agonizing pain for weeks, even months, until it heals.
Luckily for Pierce, he could benefit from an innovative surgery at Spectrum Health Butterworth Hospital called rib plating, in which titanium plates are used to stabilize broken ribs. The technique promotes healing, reduces pain and improves overall health long-term.
It has been proven to reduce the risk of death or long-term disability from the injury.
Traditionally, the treatment for broken ribs has been to let them heal on their own. And in most cases, that is still the treatment.
But with some patients, particularly those older than 65 with multiple rib fractures, the injury often proves fatal. And many who survive often need long-term ventilator support and nursing home care, said Charles Gibson, MD, an acute care surgeon with Spectrum Health Medical Group.
“When people have pain, they don’t want to take deep breaths,” he explained. “They don’t want to cough. All of that increases your risk of pneumonia.
“Usually people are fine the first couple of days, but by day three or four, they start stiffening up and having trouble breathing.”
Rib plating “really shortens the time people need to get back to their level of function,” he said.
The surgery is part of an aggressive and comprehensive approach to treating rib fractures. Care is coordinated by a multidisciplinary team, including the surgical intensive care unit, trauma, anesthesia, cardiology and post-operative rehab.
Under that program, any patient 65 or older who has three or more rib fractures goes to the intensive care unit.
“We can give them aggressive nursing care, aggressive therapy and around-the-clock breathing exercises,” Dr. Gibson said.
Spectrum Health surgeons perform rib-plating surgery on three to five patients a month. That includes young people as well as older patients.
“We typically select patients who have destructive thoracic trauma who have very poor pulmonary function as a result of their rib fractures,” said Alistair Chapman, MD, a critical care surgeon.
Although the surgery is used only in select cases, “it’s important that we have a robust program for the patients who need it, either from a functional standpoint or a functional and survival standpoint,” he said.
“The goal of our work in general is to return our patients to their previous quality of life. For a guy like (Pierce), that is so very important. He wants to play golf and be active. He wants to enjoy his retirement.”
Plates and screws
Pierce’s run-in with a deer happened less than 2 miles from his home in Greenville, Michigan.
“He called me on his cellphone and said, ‘I’m lying in the grass. A deer hit me. Can you come here?’” said his wife, Sharon.
By the time Sharon arrived at the scene, first responders were preparing to transport her husband to Butterworth Hospital in Grand Rapids. The impact of the crash had killed the deer.
At the emergency department, Pierce didn’t even want to cough, because the pain was so great. Between his injuries and other health complications, such as diabetes and heart disease, he faced a tough road to recovery.
“Based on historical data I would estimate Ken’s mortality potential at 50 percent,” Dr. Chapman said.
The next morning, Pierce lay on his side in an operating room at Butterworth Hospital. Retractors pulled back his chest muscles to expose the break in his fourth rib. At the point of the break, the front of the rib sagged.
“There is a nerve under every rib,” Dr. Chapman said. “That is irritated with every movement, every breath.”
Chapman and Brian Lapinski, DO, used a muscle-sparing technique, in which the major muscles of the chest wall are moved aside, rather than divided with an incision.
Dr. Chapman picked up a long metal plate with multiple holes and cut it so only seven holes remained. Using a tool, he ground the edges to smooth them.
He placed the plate on the rib, with the center hole positioned over the fracture. On either side, three screws were affixed to hold it in place. The two sides of the rib now lined up in its natural curved shape.
A monitor nearby displayed a 3D image of Pierce’s rib cage, with fractures marring 10 of the rib bones.
The surgical team plated six ribs, selecting the ones that would have the most impact on reducing pain and improving his ability to breathe.
After recovery from surgery, Pierce received inpatient physical therapy and returned home three weeks after the accident.
“I’m doing pretty good,” he said. “I don’t have any pain on movement. I have not had one bit of pain from that source since before the surgery, when they put the epidural in.”
Sharon, who faced her husband’s ordeal by putting “everything in God’s hands,” marveled at his recovery.
“Quite often God brings the right people together at the right time,” she said. “It’s amazing the skills he gives these people and the wondrous work that they do.”
Pierce’s twice-weekly golf habit came to an abrupt end with the accident—but only for the season. He plans for a return to the fairway when the snows melt next spring.
“It is definitely an achievable goal,” Dr. Gibson said.