Surgery offers hope for people in pain from unhealed broken ribs

March 01, 2021
A young woman rides a horse in a paddock
Hannah Campbell rides a horse, pain-free, after rib fixation surgery at MUSC Health. Photo provided 

Tracy Campbell’s little girl is all grown up and leaving home. Hannah Campbell, 18, set off from Tennessee to Colorado in January to embark on a Christian gap-year program where she expects to grow spiritually and physically – she'll be learning to ski and plans to work as a camp counselor in the mountains over the summer. After college, she’d like to pursue a career in federal law enforcement.

But none of that would be possible if Tracy and Hannah hadn’t found MUSC Health’s Evert Eriksson, M.D., they said.

After months of being told there was nothing to be done for Hannah’s unhealed broken rib, which left her in so much pain every second of the day that she couldn’t complete basic tasks like reaching down to unload the dishwasher, Eriksson performed a rib fixation surgery, attaching a titanium plate to the rib to hold it in place so it could finally heal.

Suddenly, Hannah’s future transformed. Instead of a life of pain, barely holding down a minimum wage job, the entire world opened up to her.

“That was the hardest part, feeling like there was no hope,” Tracy said of the months before they connected with Eriksson. “And if we hadn’t persevered, Hannah would be a disabled person for life.”

The Campbells wanted to share their story to spread the word that there are treatments available for unhealed broken ribs.

Eriksson has been trying to spread the word to doctors in the South Carolina Lowcountry. In 2020, he started a rib fracture clinic that takes referrals from providers from across the state and, lately, across the Southeast. The issue, he said, is that doctors are taught in medical school that broken ribs heal on their own, and there’s nothing to be done beyond pain management.

“It's a weird ask of physicians because they were all taught in medical school there’s absolutely nothing to do for rib fractures – so why would you have a rib fracture clinic? It’s been an educational event,” he said.

Although most rib fractures do heal on their own, some don’t. And patients with these nonunion rib fractures find themselves with few options.

“There is a clear group of patients that benefit from surgical rib fixation after they break their ribs. Less is known about ribs that do not heal,” Eriksson noted. However, he added, “A lot of us who have operated on nonunion rib fractures have similar results to Hannah’s – the patient feels considerably better.”

A girl is loaded into the back of an ambulance 
Hannah is loaded into an ambulance after the accident. Photo provided

Hannah’s medical journey began with an Ultimate Frisbee tournament on Nov. 16, 2019. Growing up on a farm in the mountains of Tennessee, Hannah enjoyed a very active lifestyle, and the flying disc sport was just one part of it. But on that day, Hannah and another player were both going for the same disc.

“We collided at full speed in opposite directions, so I got hit pretty hard,” she said.

Hannah doesn’t recall the immediate aftermath of the accident, but her mother does. She said Hannah was clearly stunned and started going into shock, shivering intensely. But when someone tried to drape a blanket over her shoulder, she cried out in pain. An ambulance took them to the local emergency room, where they were told that Hannah had bruised a rib, and they should go home and rest.

They immediately knew that this information couldn’t be correct, Tracy said. Hannah couldn’t walk without help.

“The first few nights Hannah was sitting up in a chair to sleep because she couldn’t breathe. She actually collapsed a lung,” Tracy said.

The family followed up with Hannah’s primary care doctor about a week later. He ordered X-rays, which confirmed that Hannah had broken at least one, and possibly two, ribs. He told them that broken ribs usually take four to six weeks to heal, and that Hannah should take it easy. But four weeks came and went, then five weeks, and then six. Hannah was still in pain. At a return visit, her doctor acknowledged that the rib hadn’t healed but didn’t have any further suggestions.

It’s hard to say why rib fractures sometimes don’t heal, Eriksson said. If there’s too much movement in the area, the bones might not have the chance to heal.

Meanwhile, during that six weeks, there were a few moments when Hannah had such trouble breathing that her mother thought about taking her back to the ER, yet she didn’t want to put her daughter through more of an ordeal only to be told there was nothing wrong.

“I pretty much couldn’t do anything,” Hannah said. “It got really frustrating because I was still in the same amount of pain that I was in the beginning, but everybody was expecting me to get better, so they were like, ‘There’s no way you can be in that much pain.’ So I had to try to fake not being that hurt. But it hurt every second of the day.”

Frustrated, at the two-month mark, Tracy took Hannah to the ER at a children’s hospital an hour away. There, a doctor validated their concerns.

“He said, ‘You are warranted to be concerned because it does give indication it’s not going to heal, but I don’t know where to send you,’” Tracy recounted. “But at least for the first time, we had someone who acknowledged the fact that it might not heal.”

The pediatric emergency doctor was also the first to alert them to Hannah’s pneumothorax, or partially collapsed lung, Tracy said. Although the doctor wasn’t sure who could help them, he did give them a referral to a pediatric orthopedic surgeon.

Thus began a journey that Tracy refers to as “the dark ages,” in which they consulted specialist after specialist, calling every hospital they could think of.

“They all said, ‘We don’t do ribs, we don’t do ribs, we don’t do ribs.’ Everybody. We just hung up and cried. There was no hope,” Tracy said. “And meanwhile, Hannah could not lift a backpack. She could not sit in a regular school chair. She could not carry in a bag of groceries. She couldn’t unload the bottom of the dishwasher. She couldn’t rotate laundry from the washing machine to the dryer. She couldn’t make her own bed because of the reaching forward motion.”

And then one night, while researching on the internet, Tracy came across Eriksson’s email address. She was stunned. After months of trying to reach people and getting no further than receptionists, here was a surgeon’s direct email address.

She sent him a brief email late on a Friday. That same night, at 10:11 p.m., Eriksson responded, saying that he’d love to try to help and the family should call on Monday morning. After months of rebuffs, Tracy was overwhelmed by that simple message. “I cried,” she said.

As it turned out, the Campbells had a choice to make. Another hospital responded to them around the same time, but Eriksson and the other surgeon offered different surgical options. The other surgeon outlined a plan to stabilize the rib in order to relieve Hannah of the pain she was in.

a hand holds a thin strip of titanium; this is used to hold the ribs in place 
Hannah holds a titanium plate like the one used in her surgery. It holds two sections of the rib in place so the bone can heal. Photo provided

Eriksson’s plan was to cut back the nonhealing bone, reestablish the intramedullary canal, and then use a titanium plate to connect the two parts of the bone so that it could regrow and heal.

When treating a broken rib, Eriksson said his preference is to operate as soon as possible after the initial injury. If that isn’t possible, then he’ll usually wait three to six months to see if the ribs heal on their own. Even if the ribs don’t completely heal, some patients don’t have pain and can still carry out their normal activities, so in those cases, surgery isn’t necessary, he said. But if the patient is in pain, then surgery may be called for. Unfortunately, the longer a person is in pain, the less likely it is that intervention can help because the nerves become chronically irritated, Eriksson said.

The Campbells decided to trust Eriksson. Hannah told her mother that, were they to choose the first procedure, she would always know in the back of her head that her rib was still broken and had simply been prevented from causing her pain. She would rather the rib have an opportunity to heal.

Beyond that, they felt an immediate personal connection to MUSC Health that started when Tracy called Shaune Shivers, an administrative coordinator within the Department of Surgery, on the Monday after she emailed with Eriksson for the first time.

“When I called Monday after contacting him, she said, ‘Dr. Eriksson told me all about you!’ We just really felt like family, like Hannah was a long-lost family member they were ready to bring home. Every single time. It was the most amazing experience,” Tracy said.

Hannah’s surgery was originally scheduled for July 2020 but had to be rescheduled to Aug. 4 because of peaking COVID-19 cases in the Charleston area.

“About two weeks after, it went from being really painful because of where the incision was to, ‘Hey I just had hiccups, and nothing hurt at all.'"

Hannah Campbell

The improvement was almost immediate. Tracy said she remembers Hannah telling her within a few days that she had pain where the incision was, but she could tell it was a different type of pain than what she had been enduring for months.

“About two weeks after, it went from being really painful because of where the incision was to, ‘Hey I just had hiccups, and nothing hurt at all,’” Hannah said.

Because of her months of inactivity, Hannah had gained weight and lost muscle on her injured side. When she began CrossFit as part of her recovery, she learned she had 17% less muscle on the left side than on the right. But after working diligently to get back in shape, she now has a bit more muscle on the left side than the right.

Today, Hannah is back to riding horses and can lift up to 125 pounds. And she’s back to having fun – squealing along with the other kids, sledding down hills after a recent snow.

Tracy thinks about the alternative future that Hannah could have been living with.

“What if I hadn’t prayed? What if I hadn’t done due diligence?” she asks. “Dr. E. literally restored her life.”

About the Author

Leslie Cantu
MUSC Catalyst News

Keywords: Features, Innovation