Plastic surgeon treats open leg fracture at 35,000 feet

By Jim Leonardo

06/24/2010 at 3:00PM

The first hour of United Airlines flight 935's journey from London to Los Angeles on May 25 was routine and uneventful. Then, in an instant, its fuselage suddenly became a chamber of horrors as the Boeing 777 encountered severe clear-air turbulence over Greenland. One particularly sharp drop caused many passengers and crew members to become violently pushed against the airliner's ceiling and overhead bins - and then as quickly and violently slammed them back down.

The incident left six injured, the most serious of which was an open-leg fracture suffered by a flight attendant - a medical emergency at 35,000 feet that prompted ASPS member Semira Bayati, MD, Newport Beach, Calif., to take action with the few medical resources on board.

"It was horrific," Dr. Bayati says of the lower-leg fracture sustained by the 50-year-old flight attendant. Dr. Bayati was one of two physicians on board, the other being an oncologist "with not much experience with fractures, much less massive, open fractures," she says.

Immediate chaos

The flight's passengers and crew were particularly vulnerable to such severe turbulence, Dr. Bayati says. "We had reached cruising altitude, the ‘fasten seatbelts' lights had been turned off and there were no storms in the area," she says. "We went from a smooth flight to chaos in literally an instant. It lasted about a full minute, although it felt like an eternity. It was so violent that it awoke my husband - anything that does that is pretty rough."

A short time later, a voice over the airplane's loudspeaker cut through the din with an urgent call for a doctor.

"I was expecting a passenger with chest pains or perhaps severe anxiety stemming from what we had just experienced," Dr. Bayati says. "After identifying myself, I was directed by flight attendants to the back of the plane, where the injured flight attendant was lying on the floor with a bleeding open wound and exposed bone through her pantyhose. I hadn't expected that."

Dr. Bayati learned through a conversation with the pain-stricken flight attendant that as she dropped from the ceiling, her leg struck the side of a wall-mounted chair in the rear galley and snapped. "I reduced the fracture, and we had to find a splint because we had to immobilize it and move her to an open seat in the first class section," she says. "One woman on board gave us one of her crutches, so we used that to stabilize the leg in tandem with the ‘demonstration' seatbelts the flight attends use. Although in shock at the bloody scene - it was quite profuse - the passengers really came through; they gave us everything they had that we asked for." That included a tab of Vicodin to help with pain relief, Dr. Bayati says.

"The airplane had very little in the way of medical supplies," she says. "It had a crash cart for cardiac victims, but no anesthesia and no pain medication, and we could not immediately find the first-aid kit with the gloves. However, I did have the supplies for an IV, so I started one and did constant neurovascular checks throughout the remainder of the flight."

Working against time

"The woman began shivering and seemed to be edging into shock," Dr. Bayati says. "Also, a two-hour window exists in which you need to surgically repair an open fracture or the probability of osteomyelitis radically jumps. On top of that, having to surgically release a possible compartment syndrome of a limb in a non-sterile environment with no cautery or anesthesia is a far cry from optimum conditions," she adds.

However, even after hearing of the injuries, the FAA originally wanted to divert the airplane to Pittsburgh or Chicago - three hours further on - until a telephone conversation between Dr. Bayati and a physician at the Pittsburgh Trauma Center and who works with the FAA concluded that the only reasonable option was Montreal's Pierre Elliott Trudeau International Airport. The paramedics and EMT transport vehicles awaiting flight 935's arrival transported the flight attendant - and a few other patients - to a nearby trauma center upon landing, more than three hours after the initial incident.

Coming home

After an eight-hour wait - another airplane was called to fly in from Chicago to complete the trip to the West Coast - Dr. Bayati was back in the air. Flight 935 was immediately taken out of service for damage inspections, according to news reports.

The flight attendant remained in Montreal in stable condition. "She was very sweet and somewhat embarrassed for ‘all the trouble' she caused. The airline has been in constant contact with me since then, offering me many nice things for what I did - but it was what any physician would do under the circumstances." Coincidentally, Dr. Bayati (picture on right) - whose practice is mainly cosmetic with a 20-30 percent reconstructive and some hand surgery ("because I like it," she says) originally weren't supposed to be on that flight. She and her husband had been booked on a Swissair flight departing the next night, but the couple's 14-month-old daughter, Kaya Bella, had developed a high fever and other symptoms that prompted them to fly home on United one night ahead of schedule.  "I was in a bad place before this emergency, because I was filled with worry about my baby girl," she says. "But the situation in the air kept my mind off that; the time passed very quickly and I didn't have time to think. I'm glad I was there to help her, because people just didn't know what to do," Dr. Bayati adds. "It was a shocking sight. Thank God I could do something good for her.

"This was a pretty strange set of circumstances," she adds. "Life has a weird way of working itself out. Things that were meant to be, will be."

 

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