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.