The Bull Shoals Lake on the Missouri and Arkansas border bustled with activity on the Friday of Memorial Day weekend as families gathered to enjoy the three-day weekend. Bored with staying indoors as he had been instructed, Ely Hamilton, 3, snuck outside to talk to his grandpa who was mowing the lawn.
“My assumption is that Ely caught his left toe under the riding mower and fell down, but we’ll never know for sure,” said Ely’s mother, Teena Merritt.
The mower blades chopped into Ely’s right leg, fracturing bones, destroying tissue and exposing his kneecap. An ambulance rushed Ely to a hospital in Springfield. Then he was airlifted to University Hospital’s Frank L. Mitchell Jr., MD, Trauma Center in Columbia.
Hundreds of miles from home
University Hospital’s trauma team was ready for Ely when he arrived in Columbia, more than 200 miles from where he was injured and his home in Aurora, Missouri. The team evaluated Ely and found no internal injuries, and he was transferred by ambulance to MU Women’s and Children’s Hospital for the pediatric team to address his leg and foot injuries.
“Ely’s worst injury was around his knee, where he had a fractured bone and had torn a lot of so tissues, including his patella, or kneecap,” said Sumit Gupta, MD, pediatric orthopaedic surgeon. “His knee was basically wide open. There wasn’t really anything left to close it with because he lost a lot of his tissue in the accident.”
That evening, Gupta performed the first of six “wash out” procedures on Ely in which he used water, saline and antibiotics to cleanse the boy’s massive wound.
“With lawn mower wounds like this, they have a lot of grass and dirt in them, which are bad for harboring bacteria,” Gupta said. “If you leave anything like that in the body, it will get infected in the long run. To clean it out is not easy because everything kind of gets stuck into the tissue and crevices. It often needs four or more wash outs to make sure it is 100 percent clean.”
Gupta oversaw all of Ely’s care at Women’s and Children’s Hospital, seeking out the appropriate MU experts needed to address his injuries.
“If I were working by myself, I couldn’t have taken care of Ely. I needed the help of foot and ankle specialists and a microvascular surgeon, and that’s what you get in an academic medical center.” Sumit Gupta, MD
Ben Summerhays, DPM, a podiatrist and foot and ankle specialist at MU’s Missouri Orthopaedic Institute, performed an operation to repair the cut tendon on Ely’s left toe. Jay Bridgeman, MD, an orthopaedic surgeon who specializes in microvascular surgery, led a flap procedure and the reconstructive surgeries that ultimately saved Ely’s leg.
“In a flap procedure, we take tissue from one site — Ely’s back, in this case — and moved it to the wounded area,” Bridgeman said. “Using a high powered microscope, I connected a blood vessel in the tissue taken from his back with a blood vessel in his leg to restore the blood supply around his knee joint.”
Teena and Ely’s father, Eric Hamilton, waited anxiously during the 12-hour flap surgery on June 18. They knew that if this procedure did not work, the next step would be amputating their son’s leg. Ely stayed in an intensive care unit for five days following the surgery. His parents recall how warm the room was — 80 degrees Fahrenheit — and the vacuum-assisted closure (VAC) pump used to create a seal around Ely’s wound to bring nutrients to the wound and help it heal.
“I was very pleased with all of Ely’s doctors and nurses,” Teena said. “They were very thorough and explained everything: where they were at with his treatment, what they were looking for and the results. Dr. Gupta was on top of everything. I remember Dr. Bridgeman coming to visit Ely after his shifts to check on him, taking extra measures.”
After 34 days in the hospital, which included Ely’s fourth birthday, Ely went home with both legs intact. He left the hospital wearing a brace on his injured leg and instructions for physical therapy sessions three times a week.
Up and running
Five months after the injury, sports medicine physician Seth Sherman, MD, examined Ely at the Missouri Orthopaedic Institute and gave the family good news. Ely’s leg was doing well and showed no signs of infection. He could bend his knee 90 degrees. Ely no longer needed a leg brace and the doctor reduced his physical therapy sessions to twice weekly.
Eric and Teena are thankful to have their son back at home, running and jumping with the seemingly boundless energy he had before the accident. Before coming to MU Health Care, she was unfamiliar with an academic medical center. Sometimes called a teaching hospital, an academic center like MU Health provides patient care, education and training for the next generation of health care professionals and research to discover ways to improve health.
“Going to a teaching hospital can be scary at first if you’ve never been to one,” Teena said. “Now that I know what it is, I think it’s the best type of hospital. As a mother, it is definitely where I want my child to be treated. You have a team of doctors consulting with each other.”
Gupta said the future looks bright for Ely as he continues to recover.
“He seems to be doing quite well,” Gupta said. “For the long term, we’ll watch for infections and monitor his growth because a growth plate on his bone was injured. That’s something we’ll follow and will address if needed. In the short term, we’ll look at his knee range of motion and his strength.
“The best thing Ely has going for him is he’s a kid,” Gupta said. “They recover marvelously and do things you would never expect.”