Elbow fracture requiring surgery. What are the pros and cons?

[tigercametotea]

My 5 year old DD jumped off the top of the couch 2 Saturdays ago and fractured her elbow. Took her to A&E and they just checked her over, x-rayed her, and sent her home in a sling saying she should be fine and to arrange a follow-up outpatient appointment in 10 days time. Well DH took her to hospital just now for the appointment and now they say she should have been put in a plaster back then when she went into A&E. Because now, her bones have become displaced, and if left untreated it will heal up into an odd shape - kind of like if she tries to straighten her arm it will bend more than most, and it will not be able to flex as fully as a normal person's arm should. In order to try and correct it, they suggest having her go into surgery ASAP (possibly today) to have wires put in her arm to correct its shape. But the surgery carries risks of nerve damage, etc... as well as the risks associated with using anaesthesia on her (she has never had anaesthesia before so this will be very much "trial and error"). I'm really at a loss what to decide now. I'm also annoyed that the doctor who treated her at A&E last did not have the sense to put her in a cast. I'm also thinking whether I should lodge a complaint. But I am probably overreacting... just feeling like crying a bit. DH called me from hospital and said he fainted on the spot when he heard what the doctor said and he feels dead embarassed about it...

Does anyone know more about this, or have experience with this sort of thing with their DC? Do you think I should let her go in for surgery or not? I told DH to have another chat with the doctor about what happens if we do not let her go in for surgery apart from developing a wonky arm. Part of me thinks that I would like to avoid surgery and its risks if the result of doing so is only somewhat cosmetic. I would rather she not go through the risks of surgery if it means she can still pursue sports (she's a very active girl and loves her ballet and swimming) despite having a rather funny shaped arm.. But as the doc did mention the possibility of her not being able to flex her arm as fully as a normal person, I wonder if I should let her go for surgery to correct it instead.

Any help appreciated, lol

ugh, sorry, didn't mean that "lol" at all. stupid phone.

Its your decision entirely but I would be inclined to go for the surgery. They have to go into all the risks but it would help if they percentageify it for you as I think nerve damage etc is quite low risk wise.

A normally functioning elbow is very important for her future development so I would not delay this, as the bones will have started the process of re knitting themselves back badly already.

I'd do the surgery. Its not going to be trial and error as anaesthetics are very routine unless she has existing medical conditions.

Not all elbow fractures need a cast, in fact many are best left uncast as the important thing is getting the joint moving.

I had an elbow fracture last year, plus recent surgery on it (its part of a complex arm injury so I've got issues round it) and you'd be suprised how much a lack of elbow movement affects you. The nerve damage risk is very small as they take great care to protect them

tiger, my friend's DS had this done last year when he was 4. Relatively straightforward surgery and he was in a cast for about 4 wks if I recall correctly.

He now has full movement and no lasting issues.

Your poor dh and dd - it is such a shock when you first hear your child has to have surgery, but she'll thank you for it in the long run.

I had a broken elbow as a child. Just put in a sling. I can't touch my shoulder with my hand on that side, but nearly can & it does bend backwards too much.
BUT - It's never bothered me, never stopped me doing anything & no-one can tell to look at it unless I bend it backwards on purpose to show them.
As I child I loved to gross people out by bending it backwards!

I would query whether the outcome if left will affect her movement very much. If she is likely to end up no worse off than me I wouldn't go for surgery - the risk of nerve damage however small isn't worth it. Sounds like there is a diff of opinion at the hospital whether it is necessary, so likely to be a borderline case?

Thanks for the responses. DH was under a lot of pressure to have the procedure done on DD it seems. He called me after signing the form saying that he was told if he didn't go footer the surgery there would be a lot of complications and problems with her elbow. She had the op yesterday and appears to have come round alright from the Propofol - the anesthesia they used on her. Now awaiting the all clear from the doctors to let her come home today hopefully. It had been a long night for me.

Glad she's doing well.

Been there and got the t-shirt. AND the t-shirt which says 'nerve damage'! DS needed a further op a few days after the one to put wires in his elbow because there was evidence of nerve damage (he lost feeling in the tips of his fingers - check this!!!!!). Op to free the squashed nerve was successful although it took about a year for the nerves to recover fully (this is normal for nerves).

Thanks titchy. I will definitely look out for that.

And yes I would complain as I'd be pissed off that my dd had to have surgery that maybe could have been avoided. Hopefully a complaint could be a constructive learning experience for the dr involved and would mean that no one else has this happen to them. It could have been that the dr had a valid reason for thinking that plaster cast wasn't needed and the displacement was a freak occurrence that wouldn't have been predicted.

Vivalebeaver, I am going to sit down and type the letter out soon. Yes I think it needs investigating. DH said the first doctor DD saw at A&E looked at her x ray that day and concluded in positive way that its just a hairline fracture and that all it Bede was a sing but said that DD didn't even need a sling if she didn't like it because it was very minor and would resolve in about a week and sent her home. She might have been justified in making that assessment, but w won't know until someone bothers to look more into this and find out if that was the case. I wouldn't want this to happen to anybody else. Stressful enough as it was for me and DH.

I've potted many a kids elbow and am a bit [hshock] that this wasnt done. I bet a nurse practitioner would have erred on the side of caution, as obviously it wasnt a hairline crack but an unstable fracture. They should always pot and let the flaming expert (orthos) make the decision a day or so later.