Special Surgery Restores Hand Function of 6-Year-Old Girl after Freak Injury

Sarah is back in action following surgery.

Sarah Cuttic is finally able to start using her right hand to write again.

Had it not been for the expert care of Dustin Greenhill, MD, FAAOS, a pediatric orthopedic surgeon with St. Luke’s Orthopedic Care, that might not be the case for the first grader in the North Schuylkill School District.

Sarah, age 6, suffered a fractured elbow in a fall from a playground zipline last May and was initially treated with surgery for what is normally a common injury but turned out to be far more severe.

“In the pediatric orthopedic world, her fracture was almost as bad as an elbow can get,” Dr. Greenhill said. The standard procedure performed on this fracture is most often performed by a pediatric orthopedic surgeon, makes it heal quickly, and does not require an incision.

“Her elbow fracture is the most common operative fracture in children,” he said. “When we got her into surgery, the fracture was so bad that it was putting her artery and median nerve at risk.”

Afterwards, however, Dr. Greenhill detected new issues with Sarah’s finger. An urgent ultrasound confirmed that Sarah had a significant problem: The median nerve was trapped inside the fracture.

“The number of times you have a nerve injury in the specific way it presented here is almost unreported in the literature,” Dr. Greenhill said. “It’s such a rare occurrence that if we did not figure this out, there would be no guarantee that the nerve would make any type of recovery, let alone a full recovery. Her hand would have been partially paralyzed.”

Dr. Greenhill performed a second surgery, this one to release the trapped median nerve, one of three nerves that control the function of the hand.

“If we had not done this, her hand function would never have returned to normal,” he said.

Dr. Greenhill specializes in pediatric orthopedic surgery and possesses extensive experience in pediatric orthopedic trauma and scoliosis. He routinely cares for these and worse pediatric injuries. In fact, he was in Philadelphia teaching other orthopedic surgeons about this exact fracture before rushing back to Bethlehem to save Sarah’s arm.

Dr. Greenhill took great care to put Sarah’s parents at ease for both surgeries. Her mom, Hilary, was with her throughout while husband Steven took care of their four-year-old son, Steven Jr.

“Dr. Greenhill was great,” said Hilary. “He answered my questions and made me feel informed. He spoke in plain English and was great with Sarah. Before the second surgery, Sarah’s index finger and thumb weren’t bending, so we figured there was some nerve damage. When Dr. Greenhill told us she needed the second surgery, we were not surprised. After explaining what needed to be done and the chance for a full recovery, we weren’t too nervous because of Dr. Greenhill’s calmness and fast scheduling. The amazing care of the St. Luke’s staff definitely helped!”

Hilary can still see the moment she saw Sarah injured

“She was on the zipline for a couple of minutes, it’s probably about six feet high,” she said. “She was hanging on it, and when it goes down, it bounces to come back. All of sudden it comes back and she’s not on it.”

Sarah went straight through the rebound area and fell to the ground.

“You could literally see her arm snap above the elbow,” Hilary recalled.

The family lives in Frackville, but Hilary and Sarah were in Jim Thorpe at the time of the injury. Sarah was transported by ambulance to the Isaacman Family St. Luke's Children's ER at St. Luke's Children's Hospital in Bethlehem. 

Hand therapy followed surgery

Post-surgery, Sarah underwent therapy once a week with Mary Ann Gimbel, PT, DPT, CHT, a certified hand and upper extremity therapist with Physical Therapy at St. Luke’s – Hometown.

“Sarah’s fracture caused her to experience a complex nerve injury manifesting as her inability to form a functional pinch with her thumb, index, and middle fingers,” says Gimbel. “The tips of these fingers would back-bend, or hyperextend, due to the lack of nerve input to the muscles involved in performing pinch activity. She required physical therapy to regain functional use of her hand and fingers.” 

Sarah’s initial treatment focused on recovery from the elbow fracture while waiting for nerve regeneration. This was followed by exercises and manual techniques to regain strength and function in the hand and fingers.

Gimbel personalized the program. Utilizing Play Doh and Silly Putty to stretch and strengthen Sarah’s hand and fingers made therapy time play time, easing the anxiety of a six-year-old. 

An integral part of Sarah’s therapy was the home exercise program Gimbel developed for consistent work at home.  Discharged from physical therapy, Sarah continues to work on her strength and stretching. “The entire family works together doing arts and crafts in order to help Sarah’s hand regain dexterity,” says Gimbel.

Back to being a kid

In late summer, Sarah began playing soccer for the first time. 

“I panic just taking her to the park to play anymore, but you have to let them go,” Hilary said. “Sarah wasn’t hesitant at all.

“Dr Greenhill was amazing seeing my daughter through a horrific break,” she added. “He was so good with my little one and explained the steps involved and the aftercare so that I could understand. He made a nervous parent feel confident.”

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