Saving Emma's Arm

Emma Peller's parents got the call one afternoon in October 2009. Their nine-year-old daughter had been on the monkey bars at her Sonora, California, school when she tumbled off -- and broke the fall with an outstretched arm that fractured just above the elbow.
 
Matthew and Tricia Peller raced to the school, concerned, but not entirely shocked. Theirs were active children, and they knew broken limbs were a painful but not particularly worrisome part of childhood. No way did they expect this seemingly-routine injury would soon require the care of one of the nation’s top trauma teams. By the end of the day, Emma would be in a helicopter en route to Lucile Packard Children's Hospital, where a multidisciplinary team of emergency surgical specialists would race to restore blood flow in her broken arm.
 
At first there was no sign such steps would be necessary. X-rays at a nearby hospital showed that the bone had split all the way through -- a supracondylar fracture. Emma was rolled into surgery that evening to reset the break and her parents were told she'd be out in an hour.
 
"We were feeling confident," Tricia recalls. "They'd fix it and we'd go home. But an hour came and went and she was still in there. Finally the surgeon finally came out and said, 'You might want to sit down.'"
 
As the surgeon explained, Emma had no pulse in the lower part of her arm. It was clear she needed the immediate care of an expert at treating damaged blood vessels. Within minutes she was being Life Flighted over a hundred miles to an emergency trauma team at Packard Children's and the care of vascular surgeon Jason Lee, MD.

Dr. Jason Lee

“It was crucial that she got to us when she did,” said Lee.
 
After appraisal, Lee and his team knew Emma needed surgery, and quickly. Pediatric injuries -- from automobile accidents, for instance, or knee dislocations after a football game -- sometimes result in arterial injuries, and Lee was familiar with Emma's particular variety. The supracondylar fracture could be renamed "the monkey bars fracture," he says, so often does it follow falls like hers.
 
There was no time to lose. An extremity that's not getting blood flow can typically go only six hours before permanent damage is done, he says -- it had been nearly that long now. Upon opening her arm, Lee saw that the brachial artery, running from the shoulder down to the elbow, had been inadvertently pinched off in the first surgery -- the screw used for the procedure was actually pushing the artery deep into Emma's elbow tissue, cutting off circulation. Lee was able to extricate and directly repair the artery, and was relieved to see that it hadn't torn; otherwise it may have required a bypass.
 
"She probably would have lost her hand if we hadn't freed the artery and restored blood flow," Lee says.  "But once we did, circulation was immediately healthy again.”
 
The crisis was over. After a day of recuperation, Emma went home. Indeed, at a follow-up appointment, Lee confirmed that her arm’s blood flow was just as it should be. Emma completed six weeks of physical therapy back home and now her middle-of-the-night visit to the pediatric emergency department is just a memory.
 
“For kids facing a limb- or life-threatening emergency,” said Craig Albanese, MD, chief of general surgery, “no one has more experience than our trauma team. We take care of some of the rarest of cases, and our Life Flight crew is standing by if a patient can’t get here by ground.” The trauma center is ranked as a Level 1, the highest level awarded by the American College of Surgeons.
 
"It was a big deal to go into that emergency surgery, but everyone reassured us Dr. Lee is one of the most sought-after vascular surgeons in the country," mom Tricia says. “We saw why.”
 
"At the end of the day, emergency vascular surgery is basically about stopping bleeding -- or in this case, making blood go where it's supposed to go," Lee says. "With kids, it's injuries like this that create the most worrisome, yet rewarding, vascular emergencies."
 
Emma, for her part, seems to have taken the incident in stride and has resumed all of her playground gymnastics.
 
"She was not fazed at all," Lee says with a chuckle. “It certainly made our entire team happy that we were able to help Emma return to a normal childhood.”