Case scenario 9

An 8 years old boy sustained a falling down injury from a tree while collecting fruit three days before he presented to our hospital. His dad witnessed a bone coming out of his right elbow which was spoiled with mud. Then the family took him to a local traditional bonesetter in hurry. There, bone outside was taken back into the elbow with the mud and tightened up with a tough splint. The boy spent a day and a night screaming at the family to take the splint away, but the family declined considering the pain as an effect of a well-functioning splint.

On a second day, as the pain endures, the family took him to the local health facility, where the splint was removed and given a referral to our hospital. They spent a night back at home and arrived at our hospital on the third post-injury day.

Upon arrival, the boy was evaluated by a senior pediatric orthopedic surgeon. He was an acutely sick looking, foul-smelling elbow wound, darkened, insensate, cold, and clumsy limb below the elbow joint. X-ray showed elbow dislocation with features of gas around the elbow. Proper emergency care was initiated and the family was counseled on the seriousness of the condition the boy had and was convinced of the plan of treatment. Later, they came up with an excuse to delay consenting for the surgery to the next day, mentioning a shortage of money as a reason.

On the next morning, they disappeared from the hospital with no notification and came back after fourth days. At that time, the patient had disseminated infection and generalized tetanus featured with nonstop muscle spasms, fever, and extreme sweating.  

Emergent amputation was done in the operation theatre and the patient was admitted to the intensive care unit (ICU). All proper medications were initiated and the patient was put on mechanical ventilation (machine breathing). Sadly, despite all the care he was provided within the ICU, the muscle spasm was unmanageable and he died after a week. This is one of the heart-breaking facts that we are facing during our clinical practice and that is why we say let’s be “Voice for the Voiceless” pediatric patients who can’t decide about their management option, where and how they need to be treated for their Musculoskeletal injury; rather their families of guardians will decide on them.