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MUSC Health Blog

Date: Jan 20, 2017

Independence Day is the worst of times and the best of times for Hyatt Kirwin. She was injured in a horrific Fourth of July boating accident in 2014. Unaware that she was climbing back aboard, the driver engaged the propeller, leaving Hyatt with five lacerations between her knee and ankle and her shin bone exposed. Unconscious, she was rushed to MUSC and awakened to find out that her tibia (the large bone of the shin) was shattered. She feared she would lose her leg. She was also afraid the disability would prevent her from starting her first job as a teacher.Hyatt Kirwin

Dr. Langdon Hartsock, a nationally renowned trauma surgeon, calmed Kirwin and assured her that she would get the best care. And even though the injury was severe, she would not lose her leg. He performed a complex surgery that day and an external fixator -- a device providing rigid immobilization with a rod on the outside of the leg – was put in. After surgery, Hyatt went home on crutches.

The Musculoskeletal Institute at MUSC Health uses an interdisciplinary approach to patient care. When Hyatt returned to MUSC in September, she had a skin graft performed by plastic surgeon Dr. Jason Ulm. Hyatt would return to MUSC again in October to have a titanium rod inserted from her knee to her ankle. After follow-up visits during the next year, Dr. Hartsock said she was healing well and could start putting weight on it. Kirwin was diligent with her physical therapy and on July 4, 2015 – her one-year anniversary of the accident – she took her first steps.

“Dr. Hartsock told me how it was, but in a way I could follow, and it never scared me. I knew after talking to him that I would be okay, and what I would have to do to walk again,” says Kirwin. “Every time someone would ask me or my parents who my surgeon was, we said Dr. Hartsock, and they replied ‘Oh you are in the best hands.’”

In June, 2016, two years after the accident, Kirwin returned to MUSC and got the rod and screws out.

Dr. Hartsock says of the surgery, “She had multiple surgeries. Obviously, the first one was the most dramatic, in which we decided that we could save her leg. Fortunately, the propeller had not damaged any critical nerves or arteries. She was very lucky!”

Her surgery was done in stages. The first called for surgically cleaning her multiple wounds and applying the external fixation. She then had a muscle flap and skin graft to close the wounds. Once the doctor was sure there was no infection, Kirwin had a plate and bone graft to get the bone to heal. More than a year later, the plate came out. 

“She has been remarkably patient. It was a process for her and her family. They had to deal with the shock and, of course, the terrible pain and multiple surgeries. I don't think anything she and her family had previously experienced could have prepared them for what happened”, says Dr. Hartsock. “She was fortunate in that she did not have any complications or setbacks.”

Dr. Ulm adds, “Hyatt remained extremely brave and positive throughout her difficult recovery. Although she suffered a devastating injury, her bravery and her family’s support led to a remarkable recovery.”

“Dr. Hartsock made me feel comfortable. We trusted him. I loved everyone at MUSC. Dr. Ulm and Physician Assistant Stacey Rothwell were amazing, as was all of the staff. In January of 2016, I was able to get back to teaching,” Kirwin says. “The school had held my position. I am now back to enjoying tennis and also walking my dog. Believe it or not, I have gotten back out on the water!”

Baseball today is nothing like it was in 1953: Pitches are faster, harder, and more frequent, training sessions are more intense, and you can participate year-round and on multiple teams. So while Little League shoulder (LLS) was first described in 1953, a lot has changed in the world of overhead throwing sports, meaning a lot has changed with this injury. Heyworth et al. explored our current state of LLS and uncovered a significant increasing trend in the past 14 years.Shoulder citation

LLS is an overuse injury specific to youth athletes when the body and bones are still growing. LLS symptoms include shoulder pain when throwing, weakness or arm fatigue, clicking noises in the arm, and shoulder instability. The study found an 8.5 percent increase in LLS diagnosis each year. Almost 90 percent of those with LLS played the pitching position, but catchers, other positions, and other sports like tennis are all at risk.

LLS can be treated with simple rest (three to four months), physical therapy, or programs to improve strength and throwing mechanics. MUSC Orthopaedics wants to help you avoid overuse injuries like LLS. If you or a family member participate in an overhead throwing youth sport, come out to the Overhead Throwing Community Workshop on February 4th where your nationally renowned shoulder, elbow, and sports medicine physicians will explain how to prevent injuries like LLS and make this season the healthiest one yet!Flyer for Overhead Throwing worship


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