Returning to the Ramp: a Broken Femur, a Difficult Decision, a Full Recovery for a Northwest Arkansas Skater

March 16, 2025, seemed like an ideal day to visit the skatepark for the Jandebeur family. Katie Jandebeur remembers it as “a beautiful, sunny day,” when she and her husband, Alex, decided to take their three children and a niece to a park in northwest Arkansas. Aiden, the oldest, was 10 years old at the time and wanted to show his father a new trick he’d been practicing on his roller skates – a “drop in” off the edge of a high ramp.

Since getting his first pair of roller skates at the age of six, Aiden has preferred skating to walking. He skates in the house, and everywhere else he’s allowed. He understands the importance of safety equipment – a helmet, knee pads and elbow pads – and wears them so often that he was geared up and at the top of the ramp with his father watching before Katie had even gotten the other kids' skates on.

The others were still at the car when Katie heard her son cry out in pain. “I knew something was wrong when Aiden screamed,” she said. “I didn't know the extent of it until I heard Alex tell me to get the girls back in the car.” She could tell by the tone of his voice that it was serious.

A Broken Femur, a Difficult Decision

Recalling his fall, Aiden says, “I felt my skate get stuck [at the top of the ramp.]”  Next, “I felt a snap and [the bone] dig into my thigh.”

Aiden’s father, Alex, has been an X-ray technician since he was 20 years old and now trains new technicians. He’s seen a lot of broken bones. “I watched Aiden catch his skate on the edge and wipe out. I watched his leg bend in a way it shouldn't. His knee ended up hitting his butt.”

As he carried his son back to the car, Alex’s mind raced through possible outcomes and choices. He knew a broken femur could heal safely with proper treatment, but he also knew a broken femur could be life-threatening.

“My brain ran through all the immediate risk elements, and I thought to myself, he may be bleeding out of his thigh and the main femoral artery.”

All bones contain blood vessels, which means a broken bone can lead to blood loss. A broken femur is especially dangerous because it’s the longest bone in the body, packed with blood vessels. Additionally, the femoral artery runs alongside the bone and can be sliced open by the jagged edge of a broken bone. Internal bleeding can lead to critical blood loss in a matter of minutes.

Alex knew the signs of rapid blood loss include confusion and cold, clammy skin. He told Katie to keep talking with Aiden while he drove toward the highway and the crossroads of a crucial decision between two hospitals. A general hospital was closer, but he knew the team at Arkansas Children’s Northwest (ACNW) specializes in the unique needs of children and teens. As Alex listened to Aiden respond to Katie’s questions, he didn’t hear signs of disorientation or slurred speech.

“I had to rapidly choose, do I take him to the nearest emergency room, or do I take him to Arkansas Children's Northwest? The difference could be living and dying. It was a longer drive for me to go to the Arkansas Children's Northwest,” he says. “But I needed the specialty care.”

Convinced the femoral artery hadn’t been cut, Alex sped toward ACNW, hazard lights flashing. Katie remembers that the younger children, piled in the backseat, didn’t grasp the urgency of the situation. “They asked if we could stop at McDonald’s.”

A Spiral, Unstable Fracture

Adrienne Koder, D.O., a board-certified pediatric orthopedic surgeon, operating room medical director, and secretary of staff at Arkansas Children's Northwest (ACNW), and an assistant professor in orthopedic surgery at the University of Arkansas for Medical Sciences, was on call that day.

“Our orthopedic physician’s assistant saw Aiden in the ER and immediately contacted me, because a femur fracture is a more urgent case in orthopedics.”

A bone fracture or break is classified as “stable” when it breaks cleanly with straight edges that can be easily realigned. When a bone gets twisted while breaking, as Aiden’s did, it creates a spiral, or “unstable” fracture.

When Dr. Koder shared the X-rays with Alex and Katie before discussing treatment options, Alex’s heart sank.

“When I saw the X-ray, it was a badly deviated, long spiral fracture, and the center of the spiral was busted off on its own piece called a butterfly fragment.” He’d seen these types of breaks before as part of his profession. He thought, “That's bad. That's really bad because, at best, it's difficult to fix. At worst, it's debilitating. I had some existential dread. That was one of the lowest points for me, seeing that initial X-ray and realizing the weight of it.”

Family members picked up the girls, allowing Alex and Katie to fully focus on Aiden’s care. The severity of the broken bone eliminated some possible treatments, such as a standard cast. Dr. Koder explained the two best options given Aiden's age and fracture type were:

• Intramedullary nailing, in which a long rod is inserted into the bone pieces to provide stability during healing, and
• Open reduction and internal fixation (ORIF), which involves fitting the bone fragments back together like jigsaw puzzle pieces and stabilizing them with a plate and screws 

“Dr. Koder did a very good job balancing the medical experience,” Katie recalled. “Alex has a medical background, and I don't, and so when she spoke with him, she was able to give him more details about the specifics. She was always kind and asked me if I had any questions. She spoke to me at my level of medical knowledge.” 

After weighing the strengths and drawbacks of each option and considering Dr. Koder’s recommendation, Katie and Alex decided on the ORIF procedure. Within a few hours of Aiden’s arrival, the ACNW orthopedic team prepared Aiden for surgery, which included using nerve blocks – numbing medication that targets specific areas of the body – to reduce the use of opioid pain medicine and speed recovery.

“Our anesthesia team is so effective and quick at doing nerve blocks,” Dr. Koder says. “It makes patients happy and families happy.”

While Aiden was in surgery, Katie and Alex researched broken femurs on the internet to prepare themselves for how the injury might affect their son. Their searches weren’t hopeful. Alex said, “It's truthfully a horrific injury, and it's hard to come back from.”

Text updates from the operating room that surgery was going well balanced out the growing fear and anxiety his parents felt.

Hours later, when the surgery was complete, Dr. Koder delivered a more detailed update. “His fracture came back together beautifully. It was very stable.”

Stabilizing the fracture is especially important for pediatric patients whose bodies are still developing, because a severe fracture can cause one leg to be shorter than the other.

“In a growing child, extra blood supply or extra healing going to that leg can make their growth plates go into hyperdrive, so they grow a little bit extra,” Dr. Koder explained. “We follow that growth over time.”

Katie said she felt relieved when Aiden woke up the morning after surgery and asked to watch SpongeBob and eat Jello – signs that her son was feeling normal.

Follow-up Femur Care

Aiden’s ACNW care team monitored his progress in the months after the surgery. One benefit of an orthopedic team with pediatric-specific training is knowing when to let a child’s body develop without intervention.

Alex said X-rays taken approximately six weeks after the surgery showed something unexpected. “That butterfly fragment, which is supposed to be lined up with the other bone, had rotated itself,” he said. “The X-ray looked awful, because it looked like there was just a bone turned sideways.”

He remembers Dr. Koder explaining how children’s bones remodel. All bones continually dissolve and reform in response to growth and stress. Children’s bones remodel much more actively than those of adults. The team would keep a close eye on the rotated fragment, but she was confident that Aiden’s bone would remodel and reshape itself without additional surgery. As more months passed, this prediction proved true.

“Less than a year after his surgery, Aiden was able to play basketball,” Katie said. “His recovery was better than we could have imagined.”

Other than having a scar on his thigh, Alex says, “It’s like he didn’t break his leg at all.”

Aiden is back on his skates and has returned to doing tricks off ramps in skateparks in northwest Arkansas.