Editor's Note: The photo of Joel and his family was taken before the COVID-19 pandemic and may not reflect current health and safety policies.
Joel Bennett had always wanted to ride a Harley Davidson to the Florida Keys. So when a friend of his who lives in Ft. Lauderdale reached out to him three years ago about doing just such a ride, Joel flew from his home in Charlotte to his friend’s house, and the duo began their adventure.
A routine ride takes a sudden turn
Joel took the bigger of the two bikes and his friend took the smaller one. “My friend’s Harley had a double exhaust on the right side. I rear-ended him when he stopped unexpectedly, and it hit my left leg. I didn’t crash or even tip over, and my friend wiped out, but he was okay,” Joel recalls. “Then I looked down and my left foot was just dangling there.” The incident happened so quickly that Joel could barely process what happened. “Usually, I say I can get out of anything, but I remember thinking to myself, ‘Joel, you can’t get out of this one’,” he explains. Joel says a good Samaritan who was nearby came to his aid and called the paramedics. An ambulance came for Joel, who was on a narrow road at the time, and drove him to the top of a nearby bridge. After that, he was airlifted by helicopter to the closest hospital.
“I don’t remember much after that,” Joel says, “But the next day, I woke up in the trauma ICU. I was confused, and I was told I was in a terrible motorcycle accident.”
The first of many surgeries
Joel had his first surgery at the hospital in Florida, where he was given a device that helped hold his leg together, since he was missing a large portion of bone in his leg. But Joel had a long road ahead of him and would require additional surgeries to fully heal his leg. His doctor in Florida referred Joel to Dr. Joseph Hsu at Atrium Health, telling Joel that Dr. Hsu was “the best when it came to limb lengthening surgery.”
After flying back to Charlotte, Joel met with Dr. Hsu and was immediately impressed with his credentials and bedside manner. “He would make sure all my questions were answered, and he helped me accept my situation. I didn’t even want to look at my leg, and he told me I had to touch it, to get used to it, that it was my new normal. He was sympathetic, but also tough, and that was just the combination I needed.”
A plan is put into place
Joseph Hsu, MD, an orthopedic trauma surgeon, is the Vice Chair of Quality at Atrium Health Musculoskeletal Institute; the Director of the Limb Lengthening and Deformity Service; and the Medical Director of Global Healthcare Services. He performed all of Joel’s surgeries following his initial surgery in Florida.
“Joel had what we call a limb-threatening injury, which basically means that his leg injury was so severe that amputation was a possibility,” explains Dr. Hsu. “Instead, he chose to have limb salvage – a series of surgeries to try to save his leg.” Joel had a severe open tibia fracture with significant loss of muscle, skin, and bone from his leg. He required flap coverage, which meant harvesting tissue from one part of his body and rotating it to cover another area.
Military experience that helps civilians, too
Dr. Hsu graduated from the United States Military Academy at West Point and served in Iraq; he also spent time as a surgeon at William Beaumont Army Medical Center and Brooke Army Medical Center. He has extensive experience working on people with injuries of a similar – or worse – magnitude as Joel’s. Dr. Hsu has also participated in studies that documented and optimized the long-term recovery associated with these types of severe limb injuries.
Dr. Hsu explains, “When Joel came to me, he was still in a difficult situation with bone loss and soft tissue loss, and trying to avoid infections. The reconstruction process with cases like Joel’s is often long and arduous.”
But Joel, and Dr. Hsu, didn’t give up.
According to Dr. Hsu, what defined his military career was his focus on optimizing outcomes for limb salvage patients. “We developed something called the Return to Run Clinical Pathway at the Brooke Army Medical Center and the Center for the Intrepid. It has now become the Return to Performance Pathway program at Atrium Health. The pathway that Joel went through is similar to the one that (Washington Football Team quarterback) Alex Smith went through with his leg injury,” says Dr. Hsu.
Innovative care helps Joel’s situation improve
In addition to the stabilizing surgeries and flap reconstruction Joel had, he was also given an implant coated with antibiotics. “This is an innovation that helps prevent further infection,” says Dr. Hsu. Dr. Hsu was recently chosen by the Department of Defense to co-lead a multi-center clinical trial (with Rachel Seymour, PhD, Vice Chair of Research at Atrium Health Musculoskeletal Institute) in conjunction with other leading trauma centers across the southeast region on using antibiotic-coated nails for severe injuries like the kind Joel had.
Joel also required several subsequent surgeries to help him fully recover, as he had a “non-union” which meant the bone didn’t heal all the way – a common scenario with severe injuries like Joel’s. “These types of processes can take up to three years including the entire recovery process,” says Dr. Hsu.
Dr. Hsu also used a process called ON path, or Outpatient Non-union Pathway, which meant Joel spent less time in the hospital. Instead of being kept in the hospital for several days after more traditional non-union surgery, the newer techniques and pain management allowed him to go home the same day. “Numerous studies have demonstrated the benefit of avoiding or having shorter stays in the hospital in after surgery, and we are applying these principles to non-union surgery,” says Dr. Hsu.
Staying the course yields results
Although there were times that Joel feared his leg, and his life, would never be the same again, he remained committed to the healing process throughout his multiple surgeries – eight in total – and rehabilitation, getting fitted for a custom brace and gradually getting back to the gym and to running. “I sometimes had to wear a brace when I walked,” Joel says, “because my foot would still drag. And for a long time, I would cover up my leg when I went anywhere.”
In December 2020, Joel ran his first 5k race since his accident. And recently, Joel went skiing with his wife and son and was able to ski without the help of a brace.
“I’m so grateful to Dr. Hsu and his entire team,” says Joel. “To be able to get the type of care I got right in Charlotte with Dr. Hsu is just amazing. Everyone I talk to says he’s the absolute best at limb salvage. Every day, I’m amazed at what he was able to do, considering how complex my case was – from the hardware, to the reconstruction, to the way he took the skin from the back of my leg and put it in the front, to the time I had to battle an infection – it was amazing.”
