Sunday, March 5, 2023, started off as the best day for 2-year-old Judge Jenné, his brothers, Jagger, 6, and Juke, 4, and his parents, Hope and Justin.
On this clear, beautiful day they came home from church and went for a trail ride — Judge’s first. The trail ride couldn’t have gone any better, and upon returning to the barn, the boys went outside to play.
Within minutes, Hope and Justin heard the boys screaming just outside the barn. Hope ran outside and saw Jagger trying to pull Judge out from under the family’s golf cart. The boys had been driving the cart, and Judge’s head had been struck.
When Hope got to Judge, she remembers that the right side of his head looked fine, just a little dirty, and his face at first seemed untouched. But as she got closer to his left side, she saw blood pouring from the side of his severely damaged head.
“There was no hair, no skin, no skull,” she remembers, and the dura, the thick membrane that surrounds the brain, was exposed. “All I could see was exposed brain and blood gushing down the side of his body.”
Hope started screaming for Justin who immediately took Judge. Hope, in shock, asked what she should do. Justin told her to call 911.
Jagger asked, ‘Is Judge going to heaven?’ Hope recalls. She didn’t know at that moment whether he would survive his injury, but confidently told Jagger, “Judge is going to be fine. You just need to pray,” she said.
“We were able to keep Judge alert the whole time; that was the main thing the lady on the call said, to keep him alert and as flat as possible, but he was turning yellow, and his eyes were rolling back in his head. We were losing him,” Hope said. “My husband was holding him, and I’m talking to him, ‘I love you, Judge. Stay with us, Judge.’ Over and over as I’m compressing his brain with a paper towel,” she said.
It took the ambulance 12 minutes to get to their barn. “It felt like an eternity,” Hope said. The local EMS team worked to stabilize him before driving him to a nearby horse show grounds to meet Vanderbilt’s LifeFlight helicopter for the 20-minute flight to Monroe Carell Jr. Children’s Hospital at Vanderbilt. Justin and Hope arrived at the hospital about 40 minutes later.
“As we waited, I looked over every inch of Judge, memorizing his tiny hairs, his freckles, his skin, in total fear this would be the last time I would hold him,” Hope said after the accident. “I thought of Jagger and Juke not having their baby brother. Your mind goes wild and has a million thoughts in a split second during tragedy.”
Once in Monroe Carell’s emergency department, things moved urgently. Hope and Justin were greeted by a social worker and led to small room where they met with multiple medical personnel, including Jay Wellons, MD, MSPH, Cal Turner Professor of Pediatric Neurosurgery and chief of the Division of Pediatric Neurological Surgery.
Wellons told them that in addition to the damage to his skull, there were multiple rocks imbedded between the skull and the dura. The golf cart had pushed his head into the gravel path near the barn, taking some of the skin off and causing a skull fracture. One sharp fragment had penetrated the dura, exposing a small amount of brain. Luckily it had not cut into the Sylvian vein, a crucial vessel located about 1 millimeter away. He needed surgery right away to remove the rocks and damaged bone and to cover and protect the underlying brain since he was missing part of his skull.
“Judge had a pretty severe injury,” Wellons recalls. “One of the challenges we were facing was figuring out how to make an incision such that we’d be able to close the area where there was no skin. It was not a small area.”
The surgery, led by Wellons and William Lineaweaver, MD, professor of Plastic Surgery, was an example of the frequent collaboration between the Departments of Pediatric Neurological Surgery and Pediatric Plastic Surgery. The two departments often work in tandem when there is a complicated injury involving the skull and the scalp. In Judge’s case, scalp tissue needed to be rotated and a flap made to close the wound.
“This surgery was a close collaboration, very seamless,” said Michael Golinko, MD, associate professor of Plastic Surgery and chief of Pediatric Plastic Surgery. “As craniofacial plastic surgeons, we’re the experts on wound and skin and soft tissue coverage but also bony reconstruction of the face and skull. And neurosurgery has that complementary expertise in neurological recovery, when it’s safe to go in there and when it’s low risk to expose the protective covering of the brain. We wanted him to be healthy, not just neurologically, but we needed to make sure the scalp would be healthy enough to accommodate a large piece of custom implant (in a later surgery). It’s like a foreign body, essentially, and the scalp has to be healthy enough to accommodate that,” said Golinko, who holds who holds the Delta Dental of Tennessee’s Smile180 Foundation Directorship.
The team worked quickly. Wellons removed the damaged bone to prevent brain swelling and cleaned out the gravel. Lineaweaver made an incision and customed special flaps to cover and protect the underlying brain.
“We got the scalp closed, but he was missing a huge chunk of his skull, leaving the brain vulnerable,” Golinko said. When Judge was discharged six days later, he was sent home wearing a protective helmet that he would need to wear for the next seven months.
To prepare for the second surgery, scheduled for Oct. 5, a CT scan was taken of Judge’s skull, and with a special engineer a custom PEEK (polyether ether ketone) implant was designed specifically for the missing part of his skull.
“The implant is meant to fit like a jigsaw puzzle piece made just for Judge,” Golinko said.
“We had to let several months pass to allow for the scalp to soften and facilitate Dr. Wellons and I completing the reconstruction,” Golinko said. The extra time gave Judge’s head time to complete its period of rapid head growth (which normally slows down after the age of 2).
On Oct. 5, Wellons and Golinko operated on Judge to place the custom implant, affixing it to the skull with tiny titanium screws and plates. Judge was released from the hospital about 48 hours after the surgery and no longer needs to wear a helmet. He might need more plastic surgery in the future to improve scarring, but he’s been given a clean bill of health by his team at Monroe Carell.
Hope said that Judge “could not have had better treatment. Everybody we dealt with was absolutely perfect and wonderful.”
Judge recently came back to see Wellons and Golinko for a post-operative visit and brought his helmet for the two surgeons to sign. He still wears it when he rides horses or in his family’s four-wheelers.
“It’s been a very faith restoring process for sure,” Hope said. “Judge is absolutely phenomenal. He’s a third child in a family of all boys,” she said, laughing. “He’s very rough and tumble and very outgoing. He loves dinosaurs and horses. He wins over everybody he meets in about two seconds. He’s got a big personality.”