It brakes my heart to share tragic stories, however some stories, no matter how drastic they are, they simply have to be told.
Many times I’ve heard: “all car seats are same”, “they’ll do the job anyway”, “if they weren’t safe, they wouldn’t be on the market”, “it’s just marketing”, “it’s only for a school run/spare car/grandparents car”, “I’m a good driver”, “he/she is too old/long for rearfacing”…
Unfortunately it doesn’t work that way.
That’s a story of a 3 year old girl, who’s a miracle survivor!
Don’t leave your child’s safety to fate 🙏 Protect them by providing the safest known method of traveling in the car- rearward facing!
(This article has been translated from Polish and originally has been written by Jolanta Gromadzka-Anzelewicz and published by Nowa Trybuna Opolska 5th August 2021)
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Doctors from Namyslow saved a 3-year-old Martyna after her head got internally decapitated.
A miracle in the Trauma Centre in “Kopernik”.
“When we saw Martyna’s scan results we were terrified” – says Prof. dr. Wojciech Kloc, chief of the neurosurgery in the Gdansk hospital Mikolaj Kopernik. – It was clear on the scans that the child’s head got dislocated from the spine. It is true that we do specialize in dealing with different trauma of this part of the human body, we have even developed a proprietary method of percutaneous stabilization of this part of the spine, and we are the global leaders in this kind of treatment, however our patients have always been adults. When it turned out that all different centres refused to admit Martyna from Namyslow, we asked ourselves a question – Since we can perform such an operation on an adult why wouldn’t we try to do it on a child?
The person who decided to undertake this incredibly difficult operation was a neurosurgeon from the team of prof Kloc, dr Wojciech Wasilewski along with his assisting team of doctors; Patryk Kurland, Lukas Dylewicz (neurophysiologist) and anesthesiologist Marta Bielewicz. It’s them that made the miracle come true. It’s because of them that the three-year-old not only is alive, moves her hand, walks, but also after a rehabilitation in a good centre she has a chance to regain her full mobility and fitness.
On the 6th of July 2021 as every day the media publishes accident report. The message is laconic and deprived of emotions. It must be this way. But each of these information means a tragedy of some family.
“In Redzikow near Slupsk Volkswagen Touareg for unknown reasons drifted off the road and hit a tree. On the place of the accident are emergency services and police. From preliminary findings it seems that the driver of Volkswagen, the 52-year-old driver lost control over the car, drifted off the opposite lane and then hit a tree. As a result of the accident a 32-year-old passenger died, and the 52-year-old driver and a child had been transported to a hospital in Slupsk. The biggest injury was that of the three-year-old Martyna.
Only the skin and muscles resisted
It’s a miracle that the child was alive. She was saved by the seatbelt with which she was fastened to her car seat – explains dr Wojciech Wasilewski.
– This is how the trauma occurred: the seatbelt was holding tight, but the girl was asleep and so her head was limp. The sudden hit was so hard that it caused her head to get separated in a functional sense. The skin and the muscles were holding it, but the ligaments and bones got torn apart. On the scan it was clear that the distance between the head and the rest of the body grew 2cm longer. Between the skull and the spine, the distance was 1 cm and another centimetre between the first and the second vertebrae. I have been a neurosurgeon for 30 years and I have performed on patients with injuries within this part of the body. However, none of them have ever had a dislocated head. From the paramedics’ report, who were giving first aid to the accident victims, we knew that the child was able to move her hands and legs which gave us hope, that the spinal cord hasn’t been broken. It is very rare that after such a severe trauma the vital functions were still preserved. And so, there was a lot to fight for.
It was clear that Martna could avoid the wheelchair only if she ended up in the best centre. Paramedics were calling Child’s Health Centre in Warsaw, Mother Polish in Lodz, the hospital in Szczecin but they all refused to admit the girl. It was only Children Trauma Centre in Gdansk Hospital, after a consultation with its neurosurgeons, that agreed to admit her for treatment.
They didn’t make it to the grandparents
Iwona, Martyna’s mum saw her daughter only the next day after the accident when she managed to get to Gdansk from near Opole where they lived. The girl was already in ICU. She was in an induced coma. Iwona was let in only for a little while because it’s a unit with a very high sanitary regime. However, ever since the girl was moved from a post-surgery unit to children’s surgery ward her mum is by her side all the time. The girl seems to have calmed down a lot.
Martyna went with her dad for holiday to his parents that live near Slupsk – says Iwona. The distance between their hometown in Namyslow to the grandparents’ house is about 500 km (310 miles). The grandfather especially came to pick his granddaughter up so that her journey could be safe and comfortable. The last time they had seen each other was January this year. Both him and his wife were very happy that they will spend two whole weeks with Martyna and her dad. They left Namyslow around 22.00. They were hoping to avoid the traffic jams during the night. In the morning, at around 3.30 Iwona got a text message with Martyna’s photo taken at the petrol station. It was a habit for them to stop at the station during long journeys because the girl used to get tired of the monotonous driving and they wanted to stretch. They drove that way to Slupsk very often.
They only had 20 km (12.5miles) left when suddenly, in a heavy fog, their car hit a tree. The father of the little girl died on the spot, the grandfather with numerous injuries was taken to the hospital in Slupsk and the three-year old was taken by an air ambulance to Gdansk.
Special screws, hooks, implants
Iwona was notified about the horrific accident when she was on her way to work. She is not able to describe how she felt at that moment – It knocked me off my feet – she says. She was half alive in fear about her child. Her brother offered instantly that he will drive her to see her daughter. When she was packing her suitcase, she didn’t know where she was going or for how long. When she was getting into the car her brother had already learnt that they were going to Gdansk. – Today from the perspective of time I am grateful as we couldn’t have ended up in a better place – claims Iwona. Doctor Wojciech Wasilewski explained to her that her daughter must remain in an induced coma until he can get everything needed for her surgery – implants, tools, equipment, etc. It was so that the child doesn’t move. It wasn’t really known how bad the injury to the cervical spine was was caused by the trauma during the accident. If the spinal cord had been cut, the fate of the child would have been doomed.
-We started preparing everything from the very beginning – recalls dr Wasilewski – We needed spinal implants, screws, hooks, rods all specially dedicated for children. Thankfully the big companies do have them. The problem is, how to anchor an implant well enough in a bone that in such small children is small and very soft because the callus isn’t well produced yet. In addition, with such an unstable spine the next problem is inserting the screws. With adults in order to make a hole in cortical bone, which is hard (inside a bone there is a spongy, soft part) an opening must be done with a hammer or a special reamer so that the screw can anchor properly. However, in the case of a child, when the spine is so unstable it is impossible.
A two stages surgery
The neurosurgeons from Gdansk used their own technique to insert the pedicle screws in the spine, a technique which was based upon their experience as they are pioneers on a global scale in this kind of surgeries. They ‘’adapted’’ screws from orthopedists which are normally used to fuse small knuckles in hands or toes. Those screws have a hole inside them through which something called Kirschner wire can be inserted. It’s a small, metal, very resistant rode which is there to stabilize bone fragments. It can be used for a temporary stabilization of a fracture made during a reposition and then exchange it for a plate or screws that stabilize the fracture. The Krischner wire is inserted under the control of a special navigation tool, and because those small screws are as sharp as a razor, they go into a child’s bone easily and they tap themselves in. Then normal spinal screws can be inserted into such bone.
The date of the surgery was set to 12 July.
– We had all day booked for it – says prof. Wojciech Kloc the head of the Neurosurgery department in ‘’Kopernik’’. Meanwhile, dr. Wojciech Wasilewski together with his team had dealt with it within 6 hours.
– The operation was of two stages. In the first one from the front (Martyna was on her back) the second vertebrae was fixed (first and second were damaged). The second vertebrae, which allows us to move our head, had a broken and moved part, called a tooth. This part was causing pressure on the brainstem. We had to move this damaged, dislocated part back to its place and connect it with the base of the shaft of the spine using screws. The previously mentioned orthopedic screws were used to do that. The surgery required an extraordinary precision, each move of the neurosurgeon was being controlled through the intraoperative tomography apparatus and by a neurophysiologist.
Next, the patient was turned onto her front. A computer tomography examination wad made to the cervical spine and then the surgery was carried on using the virtual scans. The Krischner wires were inserted both sides through the base of the vertebral bodies 3mm wide. Those were inserted into very small vertebral bodies – 2,3 and 4. Between the cord, nerves and vertebral artery. After checking the location of Krischner wires using the computer tomography, the stabilization of the second vertebrae was not done because of the size (it was too small) and the screws were inserted only into the cervical vertebrae 3 and 4. A special plate was fastened to the occipital bone, which was then connected by rods with the screws inserted into 3 and 4 vertebrae in order to get a stabilization that will allow the bones to grow together in the correct way and also a quick rehabilitation.
A birthday present
We got an information from the scene of the accident that the child can move her arms and legs which meant that the spinal cord has survived and maintained its primary functions – says dr. Wasilewski.
What will happen next – nobody knew at that time. The child was immobilized and so the neurological assessment was impossible.
– We were doing everything we could so that the girl is able to get up, have a rehabilitation and be able to walk. If we weren’t able to stabilize her from the front, the stabilizing system constructed at the back could have turned out insufficient. During the surgery, the neurophysiologist dr. Lukas Dylewicz was examining the activity of the nervous system and was watching it so that we don’t damage it.
At first, there was only a mere response from the right arm. When the cervical spine was already set and ready to stabilize, the improvement of the function of the remaining limbs was already clear. We could though breathe a sigh of relief only when, after waking up, it turned out that our little patient could move both her arms and legs – says dr. Wasilewski happily.
It was so, that on the day of the surgery it was Martyna’s third birthday. – We couldn’t ask for a better birthday present – says her mum touched.
It’s been over three weeks since the surgery.
My daughter is gaining energy, eats well, hasn’t got the probe anymore – says her mum, Iwona happily. An improvement is seen each day. She started exercising, she has even sat on my lap. Soon we will be going to the hospital in Wroclaw for further rehabilitation.
The rescue system worked with no flaws
The car seats don’t fulfill their role to the end – claims prof. Wojsciech Kloc, an outstanding neurosurgeon from Gansk. The weight of the head in relation to the weight of a child’s body is big and this limpness in the moment of braking that car is so big, that it has a great impact on the most delicate part of the spine – the cervical.
In prof. Kloc’ opinion it is important to say, that in the case of Martyna, the rescue services system in the Pomorskie voivodship had worked without a flaw. On the scene of the accident, she had been properly taken care of by the paramedics, knowing she might have had a spine and head injury. This is not so obvious and almost 10% of injuries occur due to an insufficient rescue care. And those paramedics, in Martyna’s case, deserve a word of appreciation.
It is true, Martyna was very lucky to be under the care of neurosurgeons from ‘’Kopernik’’ who have an extraordinarily big experience in treating this type of injury. No one else performs this type of surgeries.
The first cause of death
Prof. dr. Janusz Bohosiewicz, a national consultant in the field of children’s surgery emphasizes that it’s the injuries, not terminal cancer or developmental defects are the first cause of deaths within children. He adds: – We don’t know, though, what percentage of children that survived a severe injury are left invalid. It must be taken into consideration though, that they are left invalid for the whole, long life.
