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Triathlete hit by truck and treated at BMC eyeing 2003 Ironman

By David J. Craig

Fabio Selvig was conscious for just a few seconds after the tires of an oil truck ran over his waist last year, crushing his pelvis and abdomen. He remembers the loud, clanging sound the truck made as it drove over his body and his bicycle; other details he can't bring himself to describe.

"I remember giving my phone number to a nearby construction worker right before I passed out, and someone saying, 'Start fighting, buddy, you're not supposed to die like this,'" says Selvig. The 34-year-old Arlington resident was taking a leisurely bike ride on the morning of September 27, 2000, when he was hit on Merrit Road in Lexington.

Selvig, an Ironman triathlete who had won his division in an amateur triathlon in Ashland just 10 days earlier, certainly did not deserve to die at age 33. But he came close, breaking four ribs, suffering the collapse of both lungs, severing major arteries throughout his midsection, damaging his bladder and urethra, and having much of the skin and muscles near his abdomen, chest, and waist ripped apart. In addition, his pelvis was broken and severely displaced.

	Dr. Paul Tornetta. Photo courtesy of Boston Medical Center

Selvig was flown to Boston Medical Center by helicopter after undergoing several hours of abdominal surgery at Burlington's Lahey Clinic the day of his accident. BMC's orthopedic surgery department is considered one of the best in the country. It specializes in treating patients with severe injuries as well as athletes, and patients with serious bone injuries come from all over New England.

"The mortality rate for serious pelvic trauma is approximately 10 to 20 percent, and Fabio's injury was extremely severe," says Paul Tornetta, a MED associate professor and the orthopedic surgeon who operated on Selvig's pelvis. "Death occurs most commonly from related chest or head injuries, but also from bleeding around the pelvic area.

"In Fabio's case, half of the pelvis was completely displaced, pushed down and to the side, away from where it belongs at the base of the spine," Tornetta continues. "The bone also was broken."

Close call
Tornetta inserted seven permanent three-and-half-inch titanium bolts and two permanent four-inch-long metal plates into Selvig's pelvis to repair it. The surgery was successful, but Selvig battled for his life for a week, breathing only with the help of a respirator. He was unconscious for four days. "When I woke up, I had a lot of sharp, prickly pains," he recalls. "I had a mainline IV going straight into my chest, and if I moved even a quarter-inch, the pain was absolutely unbelievable, even though I was loaded up with morphine." His excellent physical condition helped him survive, says Tornetta. His cardiovascular system, for instance, was able to function with relatively little oxygen.

But when it became evident that Selvig would live, doctors told the athlete something he found almost unfathomable: he probably would never walk again. About two-thirds of patients who suffer a displaced pelvis eventually walk without a serious limp or a walking device such as a cane, Tornetta says, but the extent of Selvig's injury made it unlikely that he would be so lucky.

"I was dejected," says Selvig, who was at the peak of his career as a triathlete when the accident occurred. "At the same time, my perspective shifted to the fact that I was still alive. Sometimes I would think that it wasn't really that important that I would never be an athlete anymore, and about how people like Stephen Hawking live incredible lives in wheelchairs." His family began looking for a new, ground-floor apartment for him.

But Selvig's outlook soon changed. Still under the care of Tornetta, he took his first steps, with crutches, in January, while recovering at Boston's Spaulding Rehabilitation Hospital. It is typical for patients with less severe pelvic injuries to begin walking about three months after the injury, Tornetta says, but from the day Selvig began to walk, his progress accelerated dramatically.

"At Spaulding Rehab, the physical therapists first taught me how to live like a handicapped person, learning skills like getting into the shower from a wheelchair and washing with special implements and tools," he says. "But I think because of the way I'm wired as an athlete, as soon as my strength started to come back, I was determined to really dig deep within myself and challenge myself more than any other patient had ever done."

Returning to form
When Selvig began to walk again, just the weight of his upper body pressing down onto his pelvis exhausted him after about 20 minutes, and he would have to rest for the remainder of the day. "Emotionally, the rehab work was very similar to the training I would do for triathlons, and that really helped me," Selvig says. "I had to be careful to differentiate between the pain that you would consider regular workout pain, and pain that indicated I was really hurting my body. Dr. Tornetta was very helpful in that regard. He warned me that by pushing too hard, I could ruin the progress I'd made."

Fabio Selvig was run over by a truck, crushing his waist and abdomen, while riding his bicycle 14 months ago. He already has recovered more movement than some doctors thought would ever be possible, and is determined to finish the 2003 Ironman triathlon. Photo by Vernon Doucette

In March, with his range of motion very limited because the pelvis and abdominal muscles still were healing, Selvig began walking short distances without a walking device -- a feat that most patients with pelvic injuries achieve 12 to 18 months after their injury, Tornetta says.

Today, he is back at his job at Belmont Wheel Works in Belmont, working about 20 hours a week. He will need physical therapy for the foreseeable future, he says, and has constant lower back pain and occasional shooting pains in his left leg, but he can walk with relative ease and has resumed working out, running for up to 40 minutes at a time and taking 50- to 60-mile bike rides. His goal is to complete the 2003 Ironman triathlon. The most Herculean contest in sports features a 2.4-mile swim, a 112-mile cycling leg, and a 26.2-mile run.

"I don't think I'll be competitive, but it's something I want to do to see how much of my life I can get back," says Selvig, who finished 23rd out of 160 competitors, in the 1999 Ironman. "Dr. Tornetta just looks at me and chuckles to himself when he sees me these days, so I assume that means he thinks I have a chance."

7 December 2001
Boston University
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