Running Again

Flying across soccer practice fields in the northwest corner of Berkeley, Andrés Jankowski darts among his teammates as precisely as a hummingbird. He tickles the soccer ball with his feet like a magician doing sleight of hand. The sphere is here, it’s there, and then, with a kick, Andrés makes it take flight. You’d never know that two years before, the 14-year-old at Berkeley’s School of the Madeleine had two broken legs, one with a compound fracture. In December 2005, while visiting friends in Concord, Andrés borrowed a Razor scooter. Chased by another boy, and unfamiliar with the roads, Andrés accidentally shot out into traffic on the scooter. A surprised motorist on Clayton Valley Road hit him. By chance, a Concord police officer was there. She stopped traffic, and soon the unconscious Andrés was being airlifted to Children’s Hospital & Research Center Oakland. Andrés’ mother Carmen quickly heard about the accident, first after calls from his friend’s mom, and then with a call from Concord police. “Why Children’s?” Carmen asked the officer. “That’s where he needs to be,” was the reply. Carmen feared the worst. She arrived at Children’s from her north Berkeley home just in time to see Andrés on his way to the operating room. His face looked puffy. “I knew it was bad,” Carmen said. It was.

* * *

Growing up with two older brothers in Berkeley, Andrés played a lot of sports, mostly basketball. Then, for six monthsbefore he started kindergarten, his family lived near a soccer field in Florence, Italy. Watching the matches and hearing the cheering crowds, Andrés fell in love with “the beautiful game.” He played some of his first soccer matches with Italian boys in the neighborhood. He took to the sport like a natural, scoring 18 goals in his first official match. After moving back to the East Bay and starting at Madeleine, Andrés and several other boys were recruited for a first grade soccer team. Volunteer coach Miguel Jara, a former semi-pro and state team player in Mexico, built the team around his son and several other boys, including Andrés. He recognized talent when he saw it. “(Andrés) has been gifted as an athlete,” said Miguel, owner of a meat distribution company. “He basically won the games. He did everything. We called him ‘Mr. Offense’ and ‘Mr. Defense.’ He’s been my best player all these years. When he was injured it was hard for me to coach.”

* * *

With help from x-rays, James Policy, MD, a veteran pediatric orthopedic surgeon at Children’s, quickly sized up Andrés’ situation. Andrés had a broken left tibia, the larger of the two lower leg bones, and he had lost three teeth. But the worst damage was to his right leg. Andrés’ right femur, the big bone in his thigh, had broken in two places, piercing the skin. The small middle piece, about an inch long, had flipped around 90 degrees, and the leg’s main artery was injured. Dr. Policy couldn’t detect a pulse in the leg. He knew any delay in treatment could cost the boy his leg. But for a kid Andrés’ age, he knew exactly which technique would work best. It was dramatically different from that used for an adult’s injury. “We treat a lot of children with complex long-bone traumatic injuries,” said Dr. Policy. “This is the type of surgery we do frequently. Femur fractures require a certain degree of expertise; it’s one of the things that makes a pediatric trauma center necessary.” Adult treatment of a femur fracture is straightforward: Insert a metal rod through the central core of the femur and attach two screws, one at either end, to prevent twisting. But in growing kids, this procedure won’t work. It can actually cause irreparable damage to the ball-and-socket hip joint. For then–12-year-old Andrés, Dr. Policy used an external fixator. It’s a steel rod running outside and parallel to the leg. He inserted smaller rods into the two main femur sections and then attached them to the fixator rod, holding the leg bones in place. In a second surgery, the small piece of orphan bone between femur sections was removed. The external fixator worked well. It installed quickly, enabling Dr. Policy and his team to minimize how long Andrés was in surgery. It was also the best way to get his femur out to its normal length. A second fixator secured the broken tibia in his left leg.

* * *

The surgeries were successful, and the next day Dr. Policy detected a pulse in Andrés’ right leg. After six days in the hospital, Andrés went home, where a hospital-style bed had been delivered. His mother slept in the same room with him for months, ready to help. “This is the kind of injury when you’re happy if you can walk again,” said Dr. Policy. “It’s just amazing, the recovery he has had. All the credit goes to Andrés. He did all the work.” Of course, some credit must go to the body’s miraculous healing ability. It took several months, but Andrés grew new bone to fill in the gap, making his right femur whole. At first, the new bone was an ungainly lump twice as wide as the original femur. This was normal. Getting up, moving around, doing physical therapy and working the leg helped Andrés’ body sculpt the new bone into the lightweight, honeycombed, cylindrical shape of a whole and healthy femur. Credit also goes to Andrés’ coach and teammates. Miguel took Andrés, and his wheelchair when necessary, to every soccer practice and match for the entire season. Andrés remembers what Miguel said: “‘Just because you’re injured doesn’t mean you’re not part of the team.’” At Children’s, Andrés also got help from Caryn Lesko, PT, in the Pediatric Rehabilitation department. She did physical therapy with Andrés until he could get out of his wheelchair and use crutches. Then Sports Medicine physical therapist Robin Bousquet, MPT, took over. Because sports med PTs at Children’s work very closely with the orthopedic surgeons, she had already met Andrés, joining Dr. Policy at each clinic session. “It was definitely a worst-case scenario,” she said. “Andrés was the most severely injured kid I’ve had so far.” He was also one of the first to go through rehab at the sports medicine center’s new building on Children’s Hospital’s main campus. “He stood there with three teeth missing and said, ‘I want to play soccer,’” recalled Robin. “He had this drive—in his soul.” His work with Caryn and Robin took about seven months. Andrés had to do exercises: with Caryn at Children’s, at the sports med center with Robin and also at home. Robin worked hard to help him straighten his right leg, bent from contracture caused by months of less-than-full use. Sometimes the pushing, pulling and stretching hurt, but he never gave up. “You set goals they can reach, so they have success,” said Robin. She praised Andrés’ parents too: “They didn’t set any limitations for his goals.” Finally the day came they’d all been waiting for. “When we first saw him run (again), we all cried,” said Robin. “It was a beautiful sight.”

* * *

The day Andrés came home from physical therapy without his crutches, Carmen knew he’d be OK. She was so excited, she got on the phone and called the driver of the car that hit Andrés. The driver’s wife answered. Carmen told her how well Andrés was doing. “You don’t know what this means to me,” said the wife. “My husband has been so concerned, so worried.” When the driver finally got on the phone and heard about Andrés’ recovery, there were tears at both ends of the phone call.

* * *

The post-accident Andrés, once the fastest kid in school, is now second fastest. That speed helps at his favorite position on the soccer field: center midfield. “You can go anywhere you want,” said Andrés. “You run a lot more. You pass a lot, but I get some goals too. I don’t like to stand. I’d rather run.” Miguel is glad to have him back on the team. “If you look at our team play, there’s a lot of talent, but above all, the number-one quality is the fight, the heart—that’s Andrés,” said Miguel. “Now I also have other players with the desire to win; they learned that from Andrés.” Andrés is running again—fierce— and free as a hummingbird.

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