A day out mountain biking went terribly wrong for one middle-aged man in New Mexico: He ended up with a tree branch impaled in his neck.
Fortunately for the unnamed man, he had the good sense to leave the branch where it was and quickly seek help, according to a new case study published recently in the New England Journal of Medicine.
The 40-year-old, who was in good health, initially set off on his mountain bike to ride an off-road trail in New Mexico.
At some point during the ride, he fell from the bike onto a tree branch, which got lodged in his neck. The tree branch -- roughly three-quarters of an inch in diameter -- lodged more than half an inch deep into the left side of his neck, his doctors said.
Attending physician Dr. Lev Deriy, an assistant professor in the department of anesthesiology and critical care at the University of New Mexico (UNM) in Albuquerque, believes the "patient was definitely lucky considering the location of injury."
"The neck has quite a few vital organs, like the trachea, carotid artery, jugular vein and nerves just a few millimeters from the skin surface." Damage to any "could cause a quick death from massive bleeding and/or airway compromise," Deriy said.
"On the other hand, the patient's actions played a significant role in the positive outcome in this case," he noted. "After he fell and the wooden branch stuck deep in his neck, he decided not to take it out, rode his bike to his car, and drove to the nearest hospital, which was 20 miles away."
Doctors in the ER also left the branch in place. It was removed during surgery, and the man had a full recovery.
Bikers should be aware that mountain bikes and bikes designed for use on paved roads have differing safety concerns.
For example, according to a study led by Dr. Derek Roberts of the University of Calgary -- and published in the Canadian Journal of Surgery -- most street cycling accidents result from being struck by a car.
By contrast, off-road mountain bike accidents involve some sort of loss of control causing a fall off a cliff, a pathway or an embankment, the Canadian authors wrote.
In the case of Deriy and Gerstein's patient, ER physicians noted that the impaling branch had not caused any vascular damage or injury to the man's airway passages, and that the patient's decision to leave the branch in place probably prevented significant blood loss.
"In fact," noted Deriy, "it was left in place by emergency room doctors and removed only by the surgeon in operating room after general anesthesia was induced and the patient's airways were secured."
"I think the patient's ability to clearly analyze this potentially very dangerous situation and take the best course of actions in order to help himself makes this case especially unique," he said.
Dr. Rodney Baker, clinical director of the division of emergency medicine at Nicklaus Children's Hospital in Miami, agreed, "This type of injury is actually pretty uncommon."
"In my years in practice I've only seen one similar type of incident," he noted. "So it's really hard to predict with 100 percent certainty what the best course of action would be in a case as unusual as this.
"But yes, it is true that the trauma literature would support that a patient impaled in this kind of situation should not, if possible, try to remove the impaling object. Not doing so was probably helpful in arriving at a good outcome," Baker said.