When Nancy Gutierrez arrived at the emergency department in September 2007 after a bad fall crushed her arm, doctors were stunned by her X-rays. Her arm, shattered from shoulder to elbow, was such a complex break that the emergency doctors admitted they’d never encountered a break so severe.
Given the severity of the injury, Gutierrez was sent to Loma Linda University Health, where she was treated by Wesley Phipatanakul, MD, an orthopaedic surgeon who specializes in shoulder problems.
Gutierrez’s arm needed a reconstructive surgery involving reverse total shoulder replacement –– a procedure that reverses the normal structure of the shoulder joint, using the deltoid muscle instead of the rotator cuff to improve shoulder function. The successful operation remains one of Phipatanakul’s most challenging to date, but it also marked the beginning of a lasting friendship between them.
Now, 17 years later, 82-year-old Gutierrez looks back at her fall, not only grateful for the restored motion in her arm, but also for the genuine care Phipatanakul and his team showed her.
“I really thought they were going to have to take my arm off,” said Gutierrez, former director of the California Department of Fair Employment and Housing. “It was a miracle that I met Dr. P. The first thing he said to me was, ‘I’m going to fix you, don’t you worry.’”
Fixing Gutierrez’s crushed arm was not a straightforward solution. After the initial injury, Phopatanakul had to wait a week for the swelling to go before they could operate on her.
“It wasn't just the shoulder that was shattered,” Phipatanakul explained of the complex break, “but the arm bone was also fractured, creating a very unique pattern.”
Using an ice cream cone as a metaphor, Phipatanakul explains that replacing a shoulder is typically more straightforward than what was done for Gutierrez.
“The shoulder joint is like a scoop of ice cream on top of a cone,” he said. “In a typical shoulder replacement, the 'ice cream,' which is the ball of the joint, is removed and replaced with a metal ball. Meanwhile, a metal stem is inserted into the 'cone,' which represents the arm bone from the shoulder to the elbow. With a patient like Nancy, she had two different injuries combined — a shattered joint, the ‘ice cream,’ and a broken arm, leaving ‘the cone’ in pieces.”
With over two-thirds of her arm shattered, the metal stem that is typically inserted into a healthy bone during a routine shoulder replacement had to be extended all the way down the arm humerus, just shy of her elbow joint. To secure the arm, Phipatanakul and his team used cables to carefully piece the broken sections together to reconstruct the proverbial cone to create a foundation for replacing the shoulder joint.
In the months that followed the successful surgery, Gutierrez’s arm bones healed perfectly, and with physical therapy, she regained the strength to use it just as she had before. Though she is grateful for the limb-saving surgery, her gratitude toward Phipatanakul and his team is what she remembers most all these years later.
“He genuinely takes the time to understand and care for his patients and their recovery,” Gutierrez said. “He is an example of what Loma Linda aspires for all its physicians to be. And, his team is personable, kind, and even with all their clients, they don’t forget who you are.”
Gutierrez recalls a moment, years after her surgery, when she visited Phipatanakul for a routine check-up and unexpectedly ran into one of the physical therapists who had initially helped her—someone who still remembered her by name.
Her positive experience with Loma Linda Orthopaedics has led to Gutierrez recommending the department to many of her friends –– most of them avid golfers –– for shoulder replacements. “I’ve sent dozens of people to Dr. P., and they all love him. He fixes them up, good as new, and they can continue golfing and enjoying their retirement thanks to him.”
Phipatanakul credits much of his success with patients like Gutierrez and her friends to his approach in developing a partnership with patients. “It’s about building a relationship,” he said. “When you figuratively put your arm around a patient, it transforms a referral into a genuine friendship.”
Years after her surgery, Gutierrez’s shoulder replacement continues to do well. Her initial fear of losing her arm has transformed into a life with unrestricted movement, and her immense gratitude for Phipatanakul as a doctor and friend is profound.
“I was like Humpty Dumpty,” she said. “Dr. P. put me back together.”
Loma Linda University Health orthopaedic providers offer a range of treatments to get you back to living a healthy, active life. Learn more about the services offered, here.
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