Charles V. Toman, MD - 4/20/2009

Question
My 7 year old nephew broke his elbow by falling off his back stoop, about 6-8 months ago.  
Landed on his hand, and his elbow fractured.
The part of the bone that was broken healed, but there is "dead bone" and some nerve damage. He still has pain, and numbness in his middle and ring finger.
He has seen specialists in pediatric orthopedics, and was told by his doctor to stop physiocal therapy while waiting for an MRI result.
He is now back in PT and hoping it works without surgery, Any suggestions?
Thanks so much, Loving auntie.... Ms. Joey Buttendorf
We are in rural VT, USA.
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Answer
Joey,

Sorry that your nephew is having to deal with this.  It sounds like he may have Avascular Necrosis or an osteochondral lesion to one of the bones of the elbow.  The good news is that children have an amazing potential to heal and to deal with orthopaedic problems.  The bad news is that it has been 6+ months and he is still having problems.

It is very difficult for me to assess his specific situation because I can not see him, his films, or his MRI.

The best suggestion I have is to visit a major medical center that has a good orthopaedic program specifically with pediatric orthopaedic surgeons.  In your case I would check out the University of Vermont College of Medicine.  it looks like they have a relatively strong Orthopaedic program which means they likely have at least one good pediatric orthopaedic surgeon.

I hope that this helps.  Here is a link to their web page
http://www.med.uvm.edu/ortho/HP-DEPT.ASP?SiteAreaID=513

Good Luck.  please let me know if there are any questions that I can elaborate for you.  Make sure that you bring ALL records, MRI's, Xrays with you to your visit.