When Steve Krueger entered a pole barn on his farm in Plymouth, Wisconsin, to load a steer into a livestock trailer in September 2017, he could not have imagined he would soon be at the adult Level I Trauma Center at Froedtert & the Medical College of Wisconsin Froedtert Hospital.
All he wanted to do was coax the bull into the trailer. The 1,500-pound bull had other ideas.
“He was angry at the world,” said Steve, a 55-year-old factory worker who has raised cattle as a hobby for 10 years. “He didn’t want to cooperate one bit. I must have pushed him too hard and he didn’t like it. So, he pushed back.”
The bull wedged his horns under a gate that hung from a post tied to the livestock trailer. Trying to keep the bull from escaping, Steve climbed on the gate to weigh it down. That’s the moment his life was flipped upside down.
“He ripped that gate loose and tossed it and me in the air,” Steve said.
“The bull threw him in the air as high as the rafters of the barn three times,” said Steve’s wife, Paula, who was watching, horrified, from behind a gate in the barn. “As Steve was coming down the first time, the bull threw him again toward the truck, where he landed on his feet. The bull threw Steve one more time and he landed flat on his back near the trailer.”
“He pushed me around the barn for 30 seconds or so,” Steve said. “Then he put his head on my chest and pushed down with all his weight — crushed my chest like a bug. I was never so scared in my life.”
Thinking fast, Paula grabbed a garden hose. “I opened up the hose at full blast and aimed for the bull’s eyes, trying to blind him so Steve could get to safety,” she said. The animal backed off long enough to give Steve time to roll under the livestock trailer. “Paula saved my life,” he said.
Once Steve was under the trailer, he looked down at his chest, which was largely flattened. “I could actually see my heart beating and my lungs moving,” he said. “I thought to myself, ‘Boy, I really did it this time.’”
Paramedics took Steve by ambulance to Froedtert Hospital. High winds made it impossible for Flight For Life to offer quicker transport. “I heard one of the paramedics say, ‘I don’t think he’s going to make it,’” Steve said. “Now, I truly know what it means to fight for your life.”
Steve suffered extensive crush injuries, including a fractured sternum, nine broken ribs and a broken vertebra (the first one at the top of the spinal column). On most of his ribs, the cartilage that connects ribs to the sternum had fracture dislocations. In addition, his thumb was dislocated.
“Steve’s broken ribs created a condition known as a ‘flail chest,’ in which a section of the rib cage separates from the chest wall, usually due to blunt-force trauma,” said Christopher Davis, MD, MPH, a trauma and acute care surgeon on duty when Steve arrived at the Trauma Center. “This type of injury hampers efforts to breathe.”
“He came in with relatively stable vital signs, and his mental status was normal — he could communicate with us,” Dr. Davis said. “But he was in a lot of pain. An area of his chest wall was caved in. If you showed his initial CT scan to a trauma surgeon, the response would be, ‘Wow.’ The degree of instability was severe. It was amazing those broken rib ends didn’t impale his heart.”
When patients arrive at the Trauma Center, they immediately receive a quick but thorough head-to-toe evaluation. Developed by the American College of Surgeons, the highly structured process is designed to detect every injury.
“It’s a regimented, step-by-step approach to ensure we don’t miss anything,” Dr. Davis said. “We also involved Neurosurgery in the evaluation. Access to such specialists 24/7 is part of what we offer at our Level I Trauma Center.”
After evaluation, patients may go to emergency surgery or need additional imaging before being transferred to the intensive care unit (ICU). Steve needed cervical spine imaging to determine the stability of his broken vertebra.
A Complex Procedure
With life-threatening injuries ruled out, Steve remained sedated in the ICU for two days while doctors assessed the stability of his neck. “It’s important to fix an unstable neck fracture before other surgeries,” said Marshall Beckman, MD, trauma and critical care surgeon. He was Steve’s resuscitation physician and one of several doctors involved in his immediate care.
“I was in the ICU when Steve came in,” Dr. Beckman said. “On a scale of one to 10, with 10 being a lethal injury, I’d say his injury was about a seven. His blood pressure, pulse and breathing were OK, but he was in pain, as anyone with those injuries would be. The ends of the ribs move with each breath, so if they’re touching soft tissue, the nerves get irritated.”
Some Good News
Fortunately, Steve didn’t need neck surgery. A CT angiogram showed the two primary blood vessels that run through the bone and supply blood to the brain were not damaged, and an MRI showed the ligaments around the vertebrae were intact.
“The first vertebra is sometimes referred to as the Atlas because, just like that mythical figure who holds up the world, it supports the skull,” said Grant Sinson, MD, a neurosurgeon and the director of Neurotrauma. “It’s a critical structure. Injuries to that vertebra can damage the high cervical spine, resulting in quadriplegia.”
The Neurosurgery team prescribed a rigid device known as an Aspen® neck collar, which serves as a cast for the neck. Steve had to wear the collar for several months until the bone healed.
With the vertebra stabilized, Dr. Davis repaired Steve’s chest wall with a procedure known as rib plating. Titanium alloy plates are bent with a special tool to custom fit the curve of a patient’s ribs.
After the broken ribs were exposed, Dr. Davis reset each one and attached the plates to bridge the fractures in Steve’s ribs with selflocking titanium screws. At least six screws were used for each plate, with a minimum of three on each side of the break. Steve’s surgery, which took about four hours, required 10 plates and 93 screws.
“His surgery was unusual because it required bridging the cartilage that connects the rib bone and the sternum,” Dr. Davis said. “We rarely have to span across to the sternum. His injury was also unique because of the massive amount of force the bull applied to the middle of Steve’s chest.”
Ready Resources for Trauma Care
Steve’s case epitomizes the immense benefits a Level I Trauma Center provides: A team of certified trauma specialists available at all times, top-notch facilities and a highly skilled supporting team.
“Our staff is very familiar with traumatic injuries and how people recover from them,” Dr. Davis said. “All of our surgeons are board-certified in surgical critical care, and the Trauma Center readily uses all the resources needed for recovery, including post-traumatic stress disorder specialists to help patients recover from the emotional impact of their injuries, physical and occupational therapists, pharmacists, social workers, dietitians and others.
“Our Trauma Center has two board-certified surgeons available at all times. Beyond that, the facility has space for resuscitation in the Emergency Department and a trauma operating room that’s staffed 24/7 for critically injured patients. If someone comes in who is at risk of dying from injuries, we have staff and space at the ready.”
Moreover, fellowship-trained spine surgeons staff the Trauma Center 24/7. “Even for large academic medical centers that treat a high volume of trauma patients, it’s unusual to have spine surgeons at all times,” Dr. Sinson said. “We hope you don’t need us, but if you do, our Trauma Center is a treasure to have in your backyard.”
Steve is now fully recovered from his ordeal. “I’m not restricted from doing anything, although my rib cage and legs ache a lot,” he said. “I’m not sure if that’s from the incident or just from getting older.”
Looking back, Steve said he couldn’t have asked for better care. “It was exceptional,” he said. “They saved my life. I’m so grateful for the team of doctors and the Trauma Center. I’ve been given a second chance at life, and I’m going to try my best to make the most of it.”