When Impaled, Luck And Real Estate Matter Most

A miraculous recovery is expected for a 10-year old boy who, while being attacked by yellow jackets in a tree house, fell to the ground only to be impaled by a meat skewer that entered through his face diving deep into his skull to the back of his head. Seemingly catastrophic given the vital anatomy along its path, the piercing foreign object managed to bypass critical arteries and structures like the eye, brain and spinal cord.

According to University of Kansas Hospital Director of Endovascular Neurosurgery Dr. Koji Ebersole, who treated the patient,

“I have not seen anything passed to that depth in a situation that was survivable, let alone one where we think the recovery will be near complete if not complete...That's one in a million.”

How is this possible?

Penetrating injuries wreak havoc on the body, how much depends on location, location, and location (see here on surviving freak accidents). Because each type of wound takes on a unique trajectory, the trauma sustained comes down to how premier the real estate involved. In this scenario, luck was definitely on the young child’s side - which should never be undervalued. The foreign body notably managed to remain adjacent to a host of critical tissues. Though the close proximity was perilous and required intricate, focused, and controlled removal of the skewer so as not to cause more harm on the way out, a successful plan could be implemented.

It is not uncommon in penetrating injuries for the object itself to be compressing the mutilated vasculature, thereby stopping bleeding. In these types of traumas, moving the patient and attempts at removal without a systematic intervention elaborately devised can be devastating to fatal. This case demonstrated one moment of good fortune after another. For example, this was a solid linear item without jagged edges and the primary damage on the way in spared key blood vessels. It was not a bullet that fragments compounding the destruction. In gunshot wounds, for example, passage is erratic, asymmetrical and variable in depth and extent. Damage occurs from the primary insult with reverberating effects – to learn more about the negative chain reaction of such traumas review this piece on the shooting of Rep. Steve Scalise.

Modern medicine played a substantial role

For such a dangerous trauma, the luck of the times can’t be overlooked when it comes to attaining such a positive outcome. Due to the mechanism of injury including features of the jaw, management of the patient’s upper airway for the purposes of anesthesia couldn’t be performed orally so instead included nasal approaches. Modern imaging allowed the medical team to outline the exact route of the skewer from all dimensions and permitted real-time visualization of manipulations of the device.

Because the end of the object was rounded and protuberant, a number of precautions were taken should this portion start to twist or cause local bleeding or more damage when moved. The medical team was vast, exhaustive and composed of highly specialized ear, nose and throat physicians in addition to neurosurgery who could, through a series of efforts, dissect away the prominent vessels like the vertebral and carotid arteries so as to protect them from injury. Puncture of these vessels can lead to increased risks of infection, bleeding for which neurological disturbances can ensue and death.

Infection risks are always a consideration in these types of dirty wounds. Living in the post-discovery of antibiotics era, for instance, is another contributing factor to a desirable outcome as is being around in a period of such advanced drug discovery.

A band-aid and a smile

Photos of the child abound in media reports (see here). He is seen sitting upright in a hospital bed with a single band-aid across his cheek, mild bruising around his eye with some facial swelling, smiling while giving a big thumbs up.

By all accounts, this is good day for modern medicine. And an even better one for a very lucky little boy and his family.