In a few short months, back to hockey after a serious ankle fracture

Matthias Watson

Hockey is a fast game. Hockey injuries, like the one Matthias Watson suffered last winter, happen fast. “I was going for the puck when someone’s stick got caught on my skate, and I felt a crack,” says Matt, who plays for Acton-Boxborough Youth Hockey. Suddenly, he was lying on the ice, yelling in pain. “I didn’t know if it was my foot, ankle or leg, but I couldn’t put weight on it.”

Matt and his parents were soon in the office of John Cahoy, MD, PhD, a pediatric orthopedic surgeon at Emerson, where they learned that he fractured his left ankle — badly. “Matt had a triplane fracture, which is one of the more serious ankle fractures,” says Dr. Cahoy. They represent less than 10 percent of pediatric ankle fractures.

Fortunately, Dr. Cahoy had an opening the next day and could perform the required surgery: open-reduction internal fixation, which closes the gap between the bones and holds the bone in place with a screw. “We try to perform surgery within a week of the injury, as long as the ankle isn’t too swollen,” he notes.

Like the injury itself, Matt’s surgery was going to happen fast. “It’s great that Emerson has someone who specializes in pediatric orthopedic surgery, and Dr. Cahoy has an impressive background,” says Carol Watson, Matt’s mother. “But we were nervous about Matt having surgery.”

His pediatrician provided a strong endorsement. “The prospect of surgery and anesthesia can be anxiety-provoking for parents, especially when there isn’t ample time to process it,” says Jeffrey Ristaino, MD, a pediatrician at Harvard Vanguard Medical Associates-Concord. “Several of my patients have been cared for by Dr. Cahoy. He is an excellent clinician.”

Matt’s surgery went well, and the Watsons, who live in Acton, benefited from Emerson’s Pediatric Intervention Team. They support children and families while they are at the hospital. “Mallory Harrison was amazing,” says Ms. Watson about the team member who met them prior to Matt’s surgery. “She helped all of us feel calm that day.”

A patient who listened — and did the work

A few hours after his surgery, Matt went home on crutches. It was January, and his hockey season was over. “At that point, we were concerned about him getting around at school, so we got Matt a knee-scooter,” his mother recalls. Six weeks later, Matt began physical therapy (PT) at Emerson’s Center for Rehabilitative and Sports Therapies. From the beginning, Joshua Leigh, PT, DPT, saw that he was committed to getting his ankle healthy again.

“Matt was a fantastic patient,” says Mr. Leigh. “He embraced the exercises I gave him and got back to function quickly.”

Matt cites the initial appointment with Dr. Cahoy as inspiration. “I wondered if I was ever going to play hockey again,” Matt recalls. “Dr. Cahoy was matter-of-fact: he told me that if I wanted my ankle to heal, it would require effort by the physical therapy team and by me.”

Dr. Cahoy says that, when counseling kids about their physical therapy, he combines a caring attitude with a degree of seriousness. “I make it clear what they need to do to get better,” he says.

Matt heard him, and he made steady progress. “We perform a biomechanical assessment and, if surgery has been performed, work closely with the orthopedic surgeon so that we know about relevant details, such as tissue integrity,” Mr. Leigh explains. “And we look at the whole patient and ask what their goals are before staging treatment.

“For Matt, PT began with exercises to achieve gentle range of motion, manual therapy and exercises to work on his core strength. Eventually, we moved on to weight-bearing and sports-specific training that mimics skating. I gave him a home exercise program, and every day was different. The aim was to give him a stronger ankle and also make him a better athlete.”

Dr. Cahoy appreciates having an experienced group of pediatric physical therapists at Emerson. “They know my protocols for how to care for my patients, and they know the best way to move them along,” he says. “We communicate regularly.”

“Josh seemed like a sports coach, because he pushed me but held me back so that I didn’t injure myself,” says Matt. “After every PT session, I felt better. My ankle was building itself back again, my scars were fading away, and it looked like my leg again.”

Two weeks after his PT sessions began, Matt began aquatic therapy at the Emerson center, which was overseen by Ryan Stoddard, PT. This complemented his sessions with Mr. Leigh. “The combination was good for Matt,” says Ms. Watson, who observed many of her son’s sessions. “Once he began using the underwater treadmill, he really gained confidence. Josh and Ryan were outstanding. They held the bar high and didn’t allow Matt to waiver.”

It carried over at home. He may have been tired after school, but he got his exercises done. “I was really proud of him,” says Ms. Watson. “A couple of times I reminded him: ‘you want to play hockey again.’”

By May, Matt was cleared to play with no restrictions, and he went to find his skates. “They had been sitting in my bag since I broke my ankle,” Matt says. “Because the left skate had no laces, it reminded me of how swollen my ankle was and how far I’d come.”

A few weeks later, the Watsons headed to Vermont for a family hiking vacation that took them to the top peaks at Smugglers’ Notch. Matt kept up and experienced very little pain. He continued to make progress and is back where he wants to be: playing on the hockey team.

“We are incredibly pleased with the care Matt received at Emerson,” says Ms. Watson.

It is satisfying to see a young athlete work hard under the guidance of skilled physical therapists and with the encouragement of his parents, says Dr. Cahoy. “That’s why I love working with children. Most of them do unbelievably well.”