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Life After A Major Shoulder Injury: From Trauma To Triathlons

cartoon of a swimmer, biker and runner

Karen Smith does not believe in doing anything halfway—even when half her body was shattered.

“I’m somebody who does everything 100%,” she says. “Even as a teenager, I was training daily as a figure skater at 5am when my friends were just getting in from the night before. I took up running in my 20s and immediately wanted to do a Marathon”

She became a triathlete when a sports physician suggested to her that the cross training mix of running, biking, and swimming was a good option for long-term physical activity.

“At that stage, I didn’t know how to swim, and I’d never ridden a bike,” says Karen, who is also a trained physician and now the Chief Medical Officer at a pharmaceutical company.

After teaching herself the necessary skills via YouTube, Karen started doing short distance triathlons and within a year was training for an Ironman competition.

Finishers of an Ironman are required to complete the grueling 140.6-mile course—which includes a 2.4-mile swim, 112-mile bike ride, and 26.2-mile run—in under 17 hours.

In November 2007, Karen earned a coveted spot in the Ironman World Championship in Kailua-Kona, Hawaii. Triathletes in this race compete not only against other athletes from around the world, but also against 45 mile per hour crosswinds and temperatures over 100°F.

But in June 2008, a routine training ride turned into a nightmare.

The Crash

After having just moved into a new house in Delaware, Karen decided to bike ride for a couple of hours, then return home to help her husband unpack.

She was going about 20 miles an hour, and two training partners were with her. A teen driving a minivan was barreling toward her at about 50 miles an hour.

He got distracted, looking under his dashboard for his water bottle. Just as Karen was passing, the driver crossed the yellow lines into oncoming traffic. He crashed into Karen head on.

“I honestly don’t even remember the accident,” she says.


One of her training partners was injured and taken to a local Delaware hospital. Karen was so badly injured that she had to be airlifted to Penn Medicine.

“Theoretically, I should not have survived,” Karen recalls. “Both lungs had collapsed. They didn’t understand how I could even breathe. All of my ribs down one side were broken. My entire scapula was in pieces.”

“There was so much damage they couldn’t operate on me,” she adds. “They couldn’t intubate me to put me under anesthesia due to tears in my bronchus.”

Karen spent almost three weeks in the intensive care unit fighting for her life. That’s where Samir Mehta, MD, Penn Medicine’s Chief of Orthopaedic Trauma, first saw her.

Priorities and Puzzles

Dr. Mehta’s goal was just to get her back to daily living. But Karen insisted that triathlons were a part of her daily living.

“Her left shoulder was decimated,” Dr. Mehta explains. “I was hoping she wouldn’t have pain when she put on her bra or washed her hair. She wanted to compete in a full Ironman.”

After brainstorming possible procedures to repair her shoulder, Dr. Mehta explained the situation to Karen. Instead of surgery to fix a simple fracture, her surgery would be more like putting together a 3D jigsaw puzzle.

“Okay, bring it on,” Karen said. “If that’s what we have to work with, then let’s do that.”

Triathalons quote 1

Picking Up the Pieces

Karen’s shoulder was completely shattered, leaving tiny pieces of broken bone. Putting it back together would involve an intricate maze of screws and plates.

Dr. Mehta operated on her clavicle first. But that alone wasn’t enough to repair her shoulder, which was fractured in multiple places.

A few days later, he brought Karen back to the operating room. He lifted up the muscle and tissue on the back of her shoulder blade, and worked to get everything back close to where it should be.

These surgeries—one of which took six hours—were just the beginning of Karen’s recovery.

Triathalons quote 2

Two Steps Forward ...

For the next year, Karen committed herself to physical therapy almost every day. “When I wasn’t in the PT office, I would be doing PT at home,” she says. “I was told I would never swim or race triathlons again, but together with Dr. Mehta, I knew we could change that prediction.”

About a year after leaving the hospital, August 2009, Karen decided it was time to get back in the water. Her first event: The Chesapeake Bay, a 4.4-mile open water swim.

The next goal was the Ironman World Championships. Ironman Corporation doesn’t “hold over” a qualifying spot in the World Championships, but given the special circumstances, Karen was permitted to delay for a year while she continued physical therapy and recovery.

Her dream of competing at Kona came true about a year and a half after the accident.

Her husband recorded it and created a short film about Karen’s journey from triathlete to trauma patient and back again.

Karen and her husband brought the DVD to Dr. Mehta personally. He loaded the disc into his laptop, and the three of them huddled around the screen.

Scenes from the last year and a half passed before them: Karen at the top of her triathlon game. Karen in the hospital struggling for her life. Karen’s daily dedication toward recovery. Karen competing in Kona.

Dr. Mehta nearly cried.

Karen Smith Triathalon

… One Step Back

“But about a year and a half ago, the plates that were holding together my collarbone pierced right through my skin,” she says. At this point, October 2013, she and her husband had relocated to California, and had not been in touch with Dr. Mehta for a few years.

After having the plates removed at a local hospital, Karen still felt something wasn’t quite right. An X-ray revealed that the bones were once again fracturing. At her husband’s suggestion, Karen reached out to Dr. Mehta.

“Dr. Mehta went out of his way to squeeze me into his schedule. He remembered our partnership and we talked by Skype, then I flew back to Philadelphia because I knew the only surgeon who could put me back together again was Dr. Mehta.”

And he did again.

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