Tuesday, April 3, 2012

Distal Humerus Fracture Part 2

Let me start off with a couple things that people had questions on yesterday’s post. The type of cast/splint is hard to figure out. The only thing specifically stated about the splint was that it was in flexion which means it was done with her arm bent. While I have a medical background, casts/splints are something I do not know a whole lot about. Wendi commented about what is a typical cast for this type of injury.


wendiApr 1, 2012 04:07 PM

The tye of cast described is like a hard cast, it is set up like one, I.e....soft material, then wrapped material (fiberglass) that is then wet down, like a hard cast but because of the swelling they then cut the cast down each side and put it on her arm and wrapped it with an ace wrap. This is the type of cast they use when a fracture is badly swollen because the wrap can be mad looser but still keeps the arm immobile.

And Lucinda's daughter had a similar fracture:

Lucinda Apr 1, 2012 04:30 PM

My daughter had this same break when she was 7. She fell from the top step of a tall slide at the playground. She was in a lot of pain. She was very active and it was the middle of summer. The doctor made up a hard cast, but then split it with this little saw thing. Then the two pieces of the cast were put on her arm with an ace bandage. She was allowed to take the cast off for bathing and to get in the lake for a bit each day.
I was out of my mind when that happened! Three boys, never a broken bone, and then my baby girl breaks a bone!
It was a painful and difficult experience for her and she was 7 so she could at least understand what was going on. Poor sweet Ayla didn't have a clue why she was suffering so much.

Thank you ladies for sharing this information. While we can't say this is definitely the same type of splint Ayla had, it seems very likely it would be.

Another thing that I wanted to add is that the ecchymosis on the elbow area is typical with these kinds of breaks and was most likely not caused by any outer trauma that caused the break but caused by the impact of the bone breaking.

With that said…..


What Justin told the reporter:
DiPietro, 24, said the accident occurred on a rainy night in November, but he's unsure of the exact date.

DiPietro had just returned from the grocery store with Ayla. He went into his mother's home on Violette Avenue with bags of groceries in one arm and Ayla in the other.

"I was carrying her," he recalled during a Thursday interview with the Morning Sentinel. "Usually I let her walk, but it was raining out that night and it was dark."

DiPietro said he walked in the side door at 29 Violette Ave. and up a short set of stairs leading into the kitchen.

"I came up the stairs and slipped. It happened so fast, I don't know exactly how I fell on her, but I fell on her," he said. "It's burned into my brain."

His mother, Phoebe DiPietro, 47, was in the next room.

"I was sitting in the living room with my daughter, and we heard a big thump," she recalled Thursday. "I immediately went to the kitchen and Ayla was scared, obviously. I picked her up."

Phoebe DiPietro said Justin's wrist was injured in the fall, but Ayla appeared to be OK.

"I was more worried about (Justin's) wrist, because he's broken it into 39 pieces (in a snowboard accident)," she said.

Everything seemed normal afterward, they said. The family sat down for a lasagna dinner, then put Ayla into pajamas for the night."We hung out for a little while after," Justin DiPietro said. "She was a little fussy here and there, but if you'd seen her, you wouldn't have known anything was wrong with her."

The next day, DiPietro left to attend a commercial driver's license course at Lawrence Adult Education in Fairfield. Before he left the driveway, however, Phoebe DiPietro called him back in into the house.

"When I came in, she showed me Ayla's hand and it was swollen," he said.

Ayla wasn't crying, Phoebe DiPietro said. So, the family weighed a decision.

"It was my last class," Justin DiPietro said. "I paid a fairly good amount of money for that."

DiPietro considered skipping class, but his mother advised against it.

"I was, like, 'We have to bring her to the emergency room,' and she said, 'Well, she's fine right now.'"

Phoebe DiPietro said the injury appeared to be a bad bruise, but nothing serious. During the day, however, Phoebe DiPietro noticed the full extent of Ayla's swelling after looking under the toddler's sleeve.

Justin DiPietro said he left class early because he was concerned about Ayla.

"When I got home, we went to the emergency room," he said.

DiPietro said the ER staff originally thought Ayla had a deep-tissue bruise.

"I said, 'Can we still do X-rays?' And they said, 'We're still going to,'" he recalled.

A doctor told DiPietro that Ayla's forearm was broken, it might require surgery and Ayla would need to see a specialist.

Justin chose to see Dr. James Kuhn at MaineOrtho in Portland.

"He looked over the X-rays, and said, 'I don't know what they told you initially, but this isn't as bad as they said,'" Justin recalled. "They just put a splint on there with an Ace bandage. She didn't even have a cast or a sling or anything like that."

DiPietro said Ayla's arm was healing well in the days before she disappeared.

"Her arm was to the point now, before all this happened, that she was lifting it up. She wasn't bending it, but she would take (the splint) off sometimes, and she was getting to the point where she was starting to use that arm again," he said.

What Justin told the ER doctor:

HISTORY OF PRESENT ILLNESS: This is a 19-month-old girl who was being carried by her father last night, and he tripped and fell in the dark, and the grandmother found them both on the floor. He has recently recovered from a bad fracture of his left wrist which he was trying to protect as well, and the little girl was crying but did not appear to be severely injured so they did not bring her in until this morning, and they brought her in because of severe swelling noted in the left arm.

What Justin told the Ortho doctor:

HPI: Ayla is a healthy 19 month old girl who was injured three days ago. Her father was holding her, stumbled, and landed on her arm. She was seen at the hospital in Waterville and is referred down here today for follow-up.

From these versions of events, we glean the most information from Justin’s interview with the reporter and the report from the ER doctor. I am only going to compare these two to point out several inconsistencies:

1. To the reporter, Justin said it was a rainy night in November but could not remember the exact date and the rain caused him to slip and fall. According to the ER doctor, Justin tripped and fell in the dark.

2. Justin told the reporter that he slipped on “a short set of stairs”, the ER doctor did not note any stairs involved.

3. The reporter was told that Ayla was scared, while the ER doctor noted she was crying.

4. The reporter was told Justin was carrying groceries in one arm and Ayla in the other and told the ER doctor he had recently fractured his wrist and was trying to protect that as well as Ayla. Two different excuses of why he failed to not land directly on top of Ayla.

5. Phoebe told reporters Justin broke his wrist into 39 pieces in a snowboarding accident, although it was not stated if this was a recent injury or not.

6. Justin said Phoebe called him back into the house to show him Ayla's hand was swollen, the ER doctor noted no swelling in the hand.

7. Justin said Ayla's forearm was broken, both the ER doctor and the Ortho doctor called it a distal humerus fracture.

Justin said he was carrying Ayla in one arm and groceries in the other, in order for him to land on top of Ayla’s left arm she would have to be carried in his left arm, this puts her left arm in the front while her right is towards his back. The ER doctor said his left wrist was fractured recently and he was trying to protect it but if he was carrying Ayla in his left arm it would be under her, why would he need to protect it? He would throw out his right arm to catch his fall not his left.

When you carry a toddler Ayla's size and they sit on your hip, one side faces the front and one side the back, if Justin fell on top of Ayla with enough force to break her arm, why were there no other injuries to her left side. No bruising on her hip? Her leg wasn't sore?

It was stated that they had dinner and then put Ayla into pajamas. With this severe of a break, the swelling and ecchymosis are going to start appearing pretty soon after injury, I would think eating dinner and then putting on jamis would be ample time for those symptoms to start appearing. Justin stated she was fussy here and there. When was here and there? Was it when she tried using her arm?

Phoebe said she noticed Ayla's hand was swollen in the morning and told Justin before he left for class. If they knew Justin fell on her arm, why would they not check out her arm when noticing swelling on her hand?

Justin then left for his CDL class in Fairfield (page 33).  So let's go with this was his last day of driving for his CDL class, since the driving instruction was done on Saturdays. Justin stated he went to his CDL class but left early to take Ayla to the ER. We note on page 2 of the ER report on the Emergency Physician Record, the doctor saw her at 10:50 am.

Now I don't know how the Waterville ER is but I live in about the same size town as Waterville, and the one time I utilized the ER it still took me about 30 minutes to be called back and then I had to check in and wait, which took about another 30 minutes to be seen. The time noted is the time the doctor saw her. So if the dr saw her at 10:50 am, and they spent roughly an hour waiting to see the dr, 15 minutes to load up in the vehicle and get to the ER, 15 minutes for Justin to drive home from Fairfield. He would have to have left his CDL driving course at roughly 9:20 am. What time would they start driving on a Saturday?

The ER doctor noted definite rotation and angulation. A rotation fracture takes a twisting motion to break. The most common type of rotation fracture is on the ankle. Foot gets caught in a hole, when you fall it causes the ankle to twist and you have a rotated fracture. When I think of a distal humerus fracture that is rotated on a child, I think of someone grabbing the elbow area and the child trying to twist to get away. Wouldn't finger print bruises be apparent? With as big as her ecchymosis was could the finger print bruises be in that same area and the ecchymosis be hiding them?

But we do have a difference of opinion with the doctors. The ortho doctor did not specifically state a rotation fracture. Why could there be this difference? With how severe Ayla's swelling was at the ER and how young she is, it may have been hard to get a good read on the x-ray. Since the Ortho doctor did not note doing any manual manipulation for a closed reduction to fix the rotation, I think rotation was not the case. What else could have caused a distal humerus fracture? A strong impact, either from an object hitting the arm or falling onto the arm. Don't forget the odd placed abrasion on Ayla's arm.

Someone asked for a reenactment of this fall to show if it could happen this way. Without knowing where exactly Justin fell, exactly how he was carrying Ayla, where Ayla's arm was in relation to Justin's body and if Justin's full weight was solely on Ayla's arm; it would be hard to pull off a reenactment.

With all the discrepancies in Justin's story and the lack of concern for how severe Ayla's arm injury was, I don't think a reenactment is needed. Justin lied, changed stories, minimized the severity of Ayla's injury and used his own injury (who knows if it's real or not) as an excuse for not being able to keep from falling on Ayla.  

25 comments:

  1. Aint it funny how the stories often change from time to time.He has goofed up on how Ayla's arm broke,pretty soon the LE will be knocking on his door

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  2. Amanda, mama of 3April 3, 2012 at 5:06 AM

    maybe its just me, but i have 3 kids, and i DONT CARE if a doc were to laugh at me for taking my children to an emergency room.... i bring my kids to see a Doctor for ANYTHING, there are just too many "what if's" about what may seem as a minor injury! I will also add, i am a smaller, petite woman, and im going safely guess that Justinn is much bigger then myself...... but If I were to fall on my 2 year old, my 0ne year old or even my 4 year old...... i probably would have gotten up off the floor and walked rite back out to my vehicle and been in a hospital waiting room with in an hour of the fall, if i did wait til after dinner....maybe i wouldd've waited that long..(hell no, i wouldnt have waited that long)but even if i did..... i would have noticed "something wrong" by then!!!!! my sons left arm dislocated easily as a toddler, and with in seconds i knew he was injured.... im gonna guess Ayla made it obvious that she was hurt,at the very least "uncomfortable" and minimizing a childs fussiness after falling on them, FALLING ON THEM!!!!! is not a very intelligent move as a parent!!! Poor sweet baby girl you were suffering so much pain, i am so sad for you Ayla <3

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  3. I am hoping that the vigil on the 4th brings some media attention like CNN coverage. I do watch CNN frequently and it seems to have dropped of their coverage.
    As for the broken arm, there is no way that they could prove or disprove if he did something on purpose or if it was an accident. And then Phoebe backed his story up. She was there. Like she was there the Friday night ?

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  4. They'll be a full re-enactment at the trial; have no doubt about that.

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  5. Justin broke her arm in abuse. Phoebe knew it but did nothing. The next day when Phoebe saw the extent of her injury she told Justin to get her medical attention. He blew her off for his course or whatever he thought was more important. Phoebe comes up with an excuse for him and finally nags him into taking her. Phoebe would never take her by herself because she would be accused of abuse or implicate Justin.

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  6. I broke and dislocated both of my elbows as a teenager in a fall. I was in significant pain and was taken immediately to the ER. Among my 2 elbow breaks were other breaks in my wrist, hand, and fingers. I had some swelling that night and was placed in 2 full arm casts (right up to the shoulder joint). The casts were soft casts- what might today be called a splint (padding, ace bandage- but they had to be cut off) for a couple reasons- one was clearly weight, and the other was swelling. While my arms had begun to swell the swelling was going to get exponentially worse. Trust me it did.

    Also, the bruising was so significant that when my casts were removed (between 2 and 6 weeks later depending on arm) I was still badly bruised. Injuries involving the elbow area are often casted for much less time than other bone breaks because of the ease in which the joint can become more damaged due to lack of use. (Hence one of my elbows only being immobilized for about 2 weeks).

    The rest of the healing happens in a brace, sling, or removable cast. Children heal faster than teens/adults and often with far less intervention. I ended up requiring surgery for one of my injuries and that surgery was performed by the Ortho Doctor who Ayla saw (Dr. Kuhn). However, Dr. Kuhn was not immediately convinced I required surgery. It took a setback and my surgery happened more than 6 weeks after my accident.

    Here is my point- swelling can and does get worse with these types of injuries. I wouldn't be surprised if her swelling was much worse the next day. Also, I told my friends and acquaintances who asked that I had broken arms- not broken (everything really)....it's just easier and lends itself to less explaining.

    That is all I want to share. Just my experiences with a similar injury as a teen. I do NOT think that the Waterville crew is innocent...just sharing what I know in case it helps some understand what happens in a similar situation. :)

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  7. My personal experience - when I was 7 I was horsing around with my brother on his queen sized bed. There was plenty of room to wrestle and he always out-muscled me. As he was standing on one side, I decided it would be a great idea to "drop kick" him. Mid-air, he caught my leg and I fell straight down onto the bed with my arm bent behind me. I can still remember how badly it hurt.

    I tried all night to convince my parents it was broken, but they did not believe me as I was a drama queen and had also managed to move the arm a few times. They put me to bed. The next morning, my arm was unbelievably swollen, black and blue. My parents both cried and apologized, had to cut me out of my shirt and brought me to the ER right away. I was in a cast the same day.

    HOW COULD JUSTIN NOT KNOW? How could he not bring her in until THREE days later? I know how much pain there was at 7 years old and being able to express my pain. I can't even imagine how Ayla felt ..

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  8. Two statements made by Justin and Phoebe jump out quick. It proves they had not a single care about this beatiful little girl!

    Phoebe DiPietro said Justin's wrist was injured in the fall, but Ayla appeared to be OK. "I was more worried about (Justin's) wrist, because he's broken it into 39 pieces (in a snowboard accident)," she said.

    What Justin told the ER doctor:
    HISTORY OF PRESENT ILLNESS: This is a 19-month-old girl who was being carried by her father last night, and he tripped and fell in the dark, and the grandmother found them both on the floor. He has recently recovered from a bad fracture of his left wrist which he was trying to protect as well, and the little girl was crying but did not appear to be severely injured so they did not bring her in until this morning, and they brought her in because of severe swelling noted in the left arm.

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  9. And if someone could explain this to me, please!

    I have heard all these AnonAnon's talking about how great a person and father Justin is. Well, read this statement "The next day, DiPietro left to attend a commercial driver's license course at Lawrence Adult Education in Fairfield. Before he left the driveway, however, Phoebe DiPietro called him back in into the house."

    Now I take this as meaning that this great dad got up that morning, took care of his daily needs but failed to feed Ayla, clothe Ayla, Bathe Ayla, Kiss Ayla goodbye or anything else. If he had, wouldn't he have seen the swollen "hand" before Phoebe had to stop him from leaving. Can someone please explain that to me????

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  10. Justin broke his wrist in 39 PLACES in a snow boarding accident? I can't imagine how that could happen. What did he do, lose control and end up with his fist in a wall?? Sounds like some kind of a crushing type injury and falling on a wrist on snow would not cause a crush. Just wonder if this was an exageration versus how they minimized Aylas injury.

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    1. That's probably how the hole got in the wall behind PHeebs couch.

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  11. I fell once, on ice, with my two kids when they were smaller. It was 14 years ago and I remember the fall to this day. My youngest was in a car seat, so I just let him land on the ground. My older son was in my arms. It's wierd how these things stick in your brain. In seconds I was able to react knowing my youngest was going to be ok and a actually twisted so that my elbow and knee hit the ground and not my child. I plainly remember too that when he knew we were going down, he held on tighter. Technically, we fell and I fell on top of him, but my knee and elbow took most of the weight. It is really hard for me to picture how Justin landed on Ayla's arm. If his feet slipped out from under him, why didn't his knee come up? If Ayla's arm was behind him, and he tried to let his shoulder catch their fall, but why would anyone do that without sticking your elbow out??? I don't get it!

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    1. I know EXACTLY what you mean!! When my youngest son was only a couple of weeks old, I fell down a flight of stairs in a cement stairwell in a hospital, while holding him in my arms. I literally FLEW down the stairs, and somehow managed to land on both elbows and both knees. I arched my back, and enveloped him in my body instinctively, and he survived the fall completely unscathed. I, on the other hand, was pretty banged up, and a little dizzy. ( I also hit my head, because I literally balled myself around him as I fell). I understand how a person can fall holding a child and not do what you and I did, but not a person who is bonded with, and cares about the child. It is a purely instinctive act, you don't even think that you may become seriously injured, it happens so fast, and all you think is "OMG my child! I have to keep them safe!" I didn't think of it when it happened, but I knew without thinking about it that my newborn would be very injured if not worse if I landed on him, which is why I arched my back and took the impact of the fall on my elbows, knees, and head. It was NOT a natural way to land, (LOL) and exacerbated the injuries to myself because I contorted my body in such a weird way. This is what bothers me about the whole broken arm thing...I can't find any solution that explains what position JD could have fallen in that would have prevented him from protecting Ayla when he fell, and why it wasn't instinctual to save Ayla from injury regardless of his wrist injury. I'm not trying to stir up anything, or take sides, I just cannot understand how it wouldn't be automatic for any caregiver, especially a parent to do this. Maybe there is a situation I am not thinking of...PLEASE let me know if there is something that I am missing. I am truly trying to understand how his reaction to the fall factored his own well-being into it at all, when his daughter was in danger of serious injury. I can't understand how he thought of protecting his previously injured wrist. When you see a child imminently in danger, you just act, and don't have time to weigh options or consequences to yourself. Even when you are driving, and think you might be in an accident, lots of people instinctively put their arm out in front of the child if they are in the passenger seat, even if they are buckled, and even though it probably wont do any good. If there is a serious accident, it will likely further injure the driver with their arm out. This is instinct and another example of how you think to protect your children, then after the fact, it occurs to you that you may have caused yourself further injury, if it even occurs to you, because you are just glad your child is OK.

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  12. John, I don't believe Phoebe called him back in, or actually any of that entire story actually. I don't believe he left his class early. I only believe they took her to the ER, because she was probably "bothering" them with her crying and they knew it would look bad if they didn't bring her.

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    1. I don't neccessarily believe the story either Kit. My point was that this is the story Justin told the reporter. And yet, these friggin' idiots that defend him are still trying to make him out to be Aylas Savior for taking her from the Reynolds. That is what I don't get. He told them himself he didn't care about Ayla. This is just once but he has done so many times and yet they still insist he is Dad Almighty!

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  13. I find it hard to believe that he remembers every detail of the night he fell on her (I came up the stairs and slipped. It happened so fast, I don't know exactly how I fell on her, but I fell on her," he said. "It's burned into my brain) but doesn't remember the date it happened. Seems to me they did a good job of getting their stories straight about what happened but forgot to come up with a date!

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  14. To the reporter:

    Justin indicates falling going up the stairs carrying groceries and Ayla.
    Location of the fall is indicated as "OUTDOORS" since "rain" was cited as a factor contributing to Justin's fall, and it obviously does NOT rain INDOORS.

    To the ER doctor:

    Justin indicates falling in the dark, while carrying Ayla.
    "Darkness" is a condition that can happen EITHER "indoors" or "outdoors", and is therefore non-specific.
    However Justin ALSO reports that his mother, subsequently found he and Ayla, on the "FLOOR".

    "FLOOR" is an indoor-specific term.
    Notice that Justin didn't state his mother found him on the "GROUND".
    This one, single, word choice makes the two accounts given by JDiP ENTIRELY contradictory as to place.

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    1. I disagree. Rain could be a factor in why he was supposedly carrying her and not a factor in the ultimate fall. Regardless, the story's a crock.

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    2. I will start by saying that I do not believe this story either...HOWEVER, it IS possible that it was raining out, and he was opening the door at the top of the OUTDOOR stairs to get INSIDE when he slipped, and fell into the house on the FLOOR. I will say that it is unlikely, since walking up the stairs prior to opening the door would have been when he probably would have fallen, and since it was pretty cold out when this happened, I doubt the outside door was open, so he would have reached the top of the stairs, and stopped walking to open the door. He would have had to fall when he began walking again, stepping off the stairs, into the house. Its not really common to fall when you aren't moving (lol) so he probably didn't fall ON the stairs, or trip on them, because he would have been stopped by the closed door, and wouldn't have been found inside on the floor. Its more likely that they meant to convey that he fell stepping off the landing at the top of the stairs into the house, rather than walking up the stairs. All this being said, I think it is a moot point, because I think it is a made up story, and that is part of the reason that dad and grandma got the story a little wrong, because it never happened....Just sayin...IMO anyway.

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  15. Beyond The Looking GlassApril 3, 2012 at 6:14 PM

    From the beginning of the public portion of this story, Trista made it sound as if at the ER the doctors initially thought the broken arm was a child abuse injury. That was yet another lie, of many lies, on the part of Trista and her crew.

    I have looked at the ER document that her crew posted and it clearly shows that the ER doctor believed Justin's story. There is no indication whatsoever that the ER doctor, or any other doctor involved, thought that the broken arm was inflicted due to child abuse rather than an accidental fall.

    So Trista lied when she claimed that the ER doctors originally suspected child abuse, and that Justin had to talk them out of that perspective.

    With Trista and her crew it is lie upon lie. I think this whole thing is a con job. I would not believe anything they say.

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    1. Beyond the looking Glass,

      My husband works at MAINE MED in the ER in RADIOLOGY. Just in case you don't know what this means. He is involved in taking and reading the x-rays that are taken when people come into to the ER. (disclaimer: he did not work on this case or does not have direct knowledge of this patient record). I also have a pre-med background. I do know that Waterville ER documents indicated they did not handle Peds-Ortho. BUT LET ME MAKE THIS CLEAR: If a child comes in with a fracture that needs to be x-rayed IF the fracture shows any signs of Spiral fracture or rotation of fracture AS DID AYLA'S: AUTOMATIC RED FLAG, further investigation of injuries, report to DHHS AND UP THE CHAIN OF COMMAND FOR PROTOCOL AND PROCEDURE OF SUSPECTED ABUSE. Especially in a child this age and this location.

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  16. You are mistaken...she said she told the doctors at the appt she attended, and it is on the forms, they indeed noted it...she was not present at the ER visit, and never claimed to be...she did report suspected abuse at the leg injury appt as well...the ER docs were not provided with her medical records from the leg pull visit likely, as JD did not tell them about it, especially since there is a report by Trista concerning suspected abuse, which the Dr. was supposed to report (mandated reporter, even for suspected abuse, not just confirmed abuse...)to DHHS...
    Interestingly enough, I just saw a very blatant lie by Justin and Phoebe to the ER docs and triage nurse...he told them there were no smokers in the house, and that drugs and alcohol were not used...considering he had a pack of camels and an ashtray of butts(i think) on the table next to him, inside the house, for his first TV interview, I'd say he lied about the social history of his household to the docs...what a good daddy NOT

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  17. On Oklahoma news tonight our dhs system took part in the serenity reform project. This project was enacted after serenity deal who was killed after dhs placed her with her father. Maine need Ayla reform

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    1. If a doctor initially expected abuse but on hearing an explanation decided it was not abuse and not reportable, the initial suspicion would NOT be on the medical report. To put it there would put the doctor's license in jeopardy since he is a mandatory reporter. If he writes it down, he has to report. If he gives the parent the benefit of the doubt, no record is made.

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    ReplyDelete