Orthopaedic trauma team helps get Illinois man back on course after severe leg injury

The accident was devastating, potentially crippling. It looked like Elmer Lawrence would never walk without crutches again, never mind play golf.

On Jan. 4, 2002, Lawrence, then 68, was cutting logs on his five-acre property near Taylor Ridge, Illinois. "One end of the tree I was working on was on the ground, the other end was attached to the stump," Lawrence recalled. "I was cutting a smaller branch, trying to get to the thick part of the trunk. When the branch came off, I thought the tree would roll one way, but it rolled the other way--right over my lower left leg."

The tree shattered the upper portion of Lawrence's tibia, tearing away skin and exposing the bones. In shock, Lawrence crawled from the ravine to his riding lawnmower and drove home, where his wife, Naomi, and stepdaughter, Diane, tried to slow the bleeding and called 911.

Lawrence was initially treated at Trinity West in Rock Island, where doctors stabilized the leg with an external fixator (a device that consists of pins inserted through the bone above and below the injury site, connected by a series of bars and clamps). Unsure whether the leg could be saved, the doctors transferred Lawrence to University of Iowa Hospitals and Clinics, whose orthopaedic surgery services are consistently ranked among the nation's Top 10 by U.S.News & World Report magazine.

Lawrence received care from the orthopaedic trauma team led by James Nepola, M.D. The team surgically removed contaminants and damaged tissue from Lawrence's leg. Once the wound was clean, R. Kumar Kadiyala, M.D., Ph.D., performed a muscle flap procedure to cover the exposed bone and reduce the chance of deep infection.

"I went home from that first visit after about 10 days, and for the next four months, my wife had to change my dressing twice a day," Lawrence said. "She learned to become a nurse very quickly."

On May 1, when the wound was finally safe, Lawrence was readmitted for what would be the last operation on his leg. The external fixator was removed and the badly fractured tibial plateau and shaft were reconstructed with a large titanium plate and multiple screws. Afterwards, Lawrence went home again, but still could not bear weight on the leg. "I used a walker in the house, and I did some hopping on my good leg to get to meals and the bathroom," Lawrence said. "My foot didn't hit the ground until around July 1."

"Surprisingly, in August, Mr. Lawrence appeared back in the clinic and told me he was finally starting to feel like he had his old leg back," Nepola said.

With Nepola's approval, Lawrence began walking as much as possible, which led to quick and astonishing results. "He obviously worked very diligently because, beyond the initial injury, he went through soft tissue trouble, skin grafts, muscle transfers, complex internal fixation, and dermatological problems," Nepola said. "It's gratifying to work with a patient like this. To see a great recovery come out of a potential limb-losing situation, it helps medical professionals look other patients in the eye and say: 'You will walk again.'"

Lawrence traveled to Colorado, Wyoming, Montana, and Canada late last year and has since taken up ballroom dancing. Perhaps the most astounding highlight to his comeback came on the golf course. On September 30, after being told that he could not twist his lower body if he ever tried to golf again, Lawrence hit the first hole-in-one of his life.

"I'm never going to be 100 percent again, but I can get around really well," Lawrence said.

For more information, patients may call UI Health Access and ask for the Department of Orthopaedic Surgery. For consultation and referral, physicians should call UI Consult.