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Broken Tibia: Baylee’s Story

Meet Baylee

The first time Baylee Kern met Michael Denning, DPT, CSCS, Sports Physical Therapist at the Children’s Mercy Sports Medicine Center, she was just 13 years old and was suffering from chronic pain in her right knee, a common problem for someone who plays catcher on her softball team.

At the time, the seventh grader was one of the first patients at Children’s Mercy Sports Medicine Center Village West, a 13,000-square-foot gymnasium with state-of-the-art equipment all designed to aid student-athletes as they recover from sports injuries.

Michael described Baylee’s physical therapy as basic, focusing on functional movements, such as squatting and lunging. After working with Michael for two months, her knee was better. To reduce the chances that she would continue to have problems, she also decided to change positions on her team, switching to second base.

Sports Medicine, round 2

By the spring of 2019, Baylee began experiencing a completely unrelated condition in her right ankle. During one game, Baylee said the pain became severe, so her mom, Jennifer Kern, scheduled an appointment with a Children’s Mercy Sports Medicine Physician, Jay Roberson, MD.

Initially, Dr. Roberson recommended a cast to stabilize Baylee’s ankle and promote healing, but that was soon complicated by a skin infection. “Baylee also has Crohn’s disease, an autoimmune condition. She sees Julie Bass, DO, gastroenterologist at Children’s Mercy, for it,” Jennifer explained. “Crohn’s can affect her ability to heal on her own, and that makes her susceptible to secondary infections.”

Even after the cast was removed and the skin infection cleared up, Baylee’s ankle was still painful, so Donna Pacicca, MD, Children’s Mercy Pediatric Orthopedic Surgeon, offered her a surgical solution.

“I did an arthroscopy to evaluate Baylee’s joint cartilage and determine what course of action to take,” Dr. Pacicca said.

Dr. Pacicca confirmed her patient had an articular cartilage defect called osteochondritis dissecans, or OCD. OCD occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen.

During the same outpatient surgery, Dr. Pacicca drilled into Baylee’s OCD lesion using X-ray guidance. “By drilling into this area, we can create a local injury, starting a sequence of predictable events to bring in inflammatory factors that will induce a healing response, including new blood vessel formation,” Dr. Pacicca explained. “That in turn helps stimulate new bone formation in the lesion.”

After a couple of weeks on crutches, Baylee returned to begin rehabbing her ankle with Michael.

“Baylee’s second round of therapy was more complex,” Michael said. “Baylee wasn’t full weight-bearing so we had to go slow, but thanks to the Alter G treadmill we have at this facility, we were able to start some weight-bearing sooner, which really helped the healing process,” he explained.

The Alter G uses NASA-developed technology to unweight patients, which reduces the impact while walking or running during rehab. It also can record comprehensive data about an athlete’s performance so doctors and parents can stay informed on their student-athlete’s progress.

“The Alter G allowed us to stress Baylee’s system in a way that promotes healing, but doesn’t over-stress it,” Michael said. During the next few months, Baylee worked diligently with Michael to get her ankle back in shape, and by December 2019, she was released to return to play. “I really didn’t think I would see Baylee again,” Michael added.

“My ankle was feeling good and I was ready to get back out there,” Baylee said. Her freshman softball season at Pleasant Ridge High School started the first week of March 2020, but by the second week, the season was already over, this time due to the COVID-19 pandemic.

“We had a week of practice, then the entire season got shut down,” Baylee said. “I didn’t get to play ball my freshman season, and I didn’t get to see how my ankle would perform.”

But for Baylee, the silver lining to the pandemic was that the summer competitive softball season started early, and she was anxious to put her ankle to the test.

Sports Medicine, round 3

Baylee played second base all summer on her competitive softball team and her ankle held up well. Then the unthinkable happened on Oct. 25, 2020.

“I was playing second base at a tournament in Olathe, and there was a pop fly,” Baylee said. “When I went to catch it, I ran full force into a chain link fence and caught my toe a little above the bottom half of the fence.”

Baylee flipped forward over the top of the fence, but with her right foot caught on the other side, she felt the tibia, the large bone in the lower front portion of her leg, snap in two.

“I fell backward onto the ground and knew right away what had happened,” she said. “It was extremely painful.” An orthopedic surgeon from another city just happened to be on hand, watching his niece play in a different game.

“He stabilized Baylee’s injury and said she needed an ambulance to take her to Children’s Mercy immediately,” Jennifer said.

In the Children’s Mercy Adele Hall Campus Emergency Department, X-rays confirmed the break. Doctors put her leg in a cast that extended from her ankle to her hip, and the next day she saw another Children’s Mercy pediatric orthopedic surgeon.

The doctor laid Baylee’s options out for her—a cast for the next three months followed by physical therapy—or a steel rod placed in her tibia to stabilize the fracture, also followed by physical therapy.

Jennifer said Baylee’s first question was, “Will I be able to play ball again if I have the surgery?” The answer was, “Yes,” and that made the decision for her.

“Baylee wanted to continue to play ball, and surgery was the faster way for her to return to the field,” Jennifer said.

On Oct. 29, 2020, a steel rod was placed in her tibia, along with some screws in her knee and ankle. After spending the night in the hospital, Baylee returned home, but this time in a wheelchair.

“We were having in-person classes at school, so I switched to virtual classes,” Baylee said. Three weeks later she started her third, and most complex course of physical therapy with Michael at Children’s Mercy Sports Medicine.

Initially, Michael used the facility’s pool to help Baylee regain the strength and motion in her right leg. “This injury doesn’t just affect Baylee’s tibia,” Michael explained. “It affects the range of motion in both her ankle and her knee, so there are two joints to rehab. It’s a much more complicated injury to recover from.”

Working in the Village West state-of-the-art therapy pool helped Baylee feel like she was making progress during the early stages of her therapy. Even while she was still on crutches, the buoyancy of the water made it possible for her to do more with less weight on her leg.

Michael also added blood flow restriction training, or BFR, to Baylee’s therapy regimen. BFR training involves wrapping a restrictive device, similar to a large blood pressure cuff, around a limb during different forms of training and movement. Studies show BFR increases muscle growth and improves bone healing.

“By using BFR, you get similar benefits to the muscles that you would from traditional strength training,” Michael explained. “It stresses the muscles, so they get stronger, but protects the joints.

“This is where rehabilitation at the Children’s Mercy Sports Medicine Center stands out,” Michael added. “We have all these state-of-the-art tools right here for patients like Baylee that can limit pain and swelling, while improving strength and healing.

“Baylee has gone from hobbling in here on crutches and barely being able to move in the pool, to working on heavy strength training,” Michael said. “As she continues to improve, we’ll start to work on her agility, and maybe drop the batting cage down.”

Michael may even use the facility’s human performance lab to analyze Baylee’s body mechanics. The human performance lab is equipped with state-of-the-art technology including 19 3D cameras, six force plates installed in the floor to measure movement, and a 16-channel wireless EMG. The force plates measure changes in pressure and weight distribution as the athlete moves.

Reflective markers are placed on the patient’s shoulder, elbow, wrist, pelvis, hip, knee, ankle and foot. With the help of the motion capture cameras that read the markers using infrared rays, a 3D model of the patient can be created on the computer and analyzed, pinpointing potential weaknesses in an athlete’s movements, and preventing further injuries.

Anxious to get in the game

Michael thinks Baylee will play softball this season, but she may not be ready for opening day. “This process may take more time,” he said.

Though Baylee understands Michael’s concerns, after nearly 2 ½ years battling injuries and rehabilitation, she’s ready to play ball and be healthy once and for all.

“I just love playing softball,” Baylee said. “I love everything about it—the team, the memories and especially diving for a catch.”

But Baylee doesn’t want to jeopardize her chances for success, not after everything she’s been through. Instead, she’ll patiently wait until she’s cleared to play, continuing her therapy homework for 30 to 40 minutes a day, and working with Michael twice a week.

“We joke that Michael has become an adopted uncle,” Jennifer said. “We’ve spent so much time with him over the past couple of years.”

“Michael is fun to work with, but he expects a lot out of me,” Baylee said. Michael said that’s because he knows what his patient is capable of.

“Baylee is super competitive; loves sports and she thoroughly enjoys playing softball. But she’s had to go through a lot of challenges the average kid doesn’t just to be able to play softball.

“The average kid doesn’t go through physical therapy for knee pain or for an OCD lesion, or for a broken tibia. Baylee has been knocked down a lot, but she always gets up and fights back hard. That’s extremely commendable,” he said.

It’s also commendable that she’s an outstanding student, in spite of the fact that she’s had to miss a lot of school for surgeries and rehab. “Baylee is a straight-A student,” Jennifer said. “She’s maintained her grades throughout this and really enjoys math.”

One day, she even hopes to play softball in college, and follow in Michael’s footsteps, becoming a physical therapist herself.

“Michael has really inspired me to consider physical therapy as a career,” she said.

It’s the staff

Thinking back, Baylee’s had the opportunity to recover from three very different injuries in one of the most sophisticated sports medicine facilities in the region, but Baylee and her mom are quick to point out they believe the care she’s received has made all the difference.

“I’ve been very happy with the Children's Mercy team,” Jennifer said. “They have all been very invested in helping Baylee get back to doing what she wants to do. No one has ever said, ‘Well, you’re going to have to give up softball.’ They have been very encouraging.

“Baylee has had to work hard, especially this time, so she can return to softball. It’s been a lot for her to overcome and she’s done a great job.”

Michael agreed. “Baylee is a hard worker. She’s a good example of someone who keeps hitting her marks consistently because she puts the effort in. She’s learned a great life skill and it shows every time she comes to the gym.”

“Not a lot of people believed I would be able to come back from this injury,” Baylee said. “I’m looking forward to playing softball again and showing them, I can do this.

“The Children’s Mercy Sports Medicine Center at Village West facility is amazing,” Baylee said, “But the staff is what makes it great.”


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