On Saturday, January 14, 2006, Brittany was in Humble, competing on the uneven
parallel bars in her first gymnastics meet of the season. An experienced gymnast
with four years of competition behind her, Brittany went into a handstand on the
high bar, then overshot the low bar and landed on the mat. With too much power
behind the move, she landed hard, snapping the bones of both forearms in
compound
fractures that broke through her leotard.
The 13-year-old was rushed to Children's Memorial
Hermann Hospital, where orthopedic surgeon Jorge Casas, MD, cleaned the
wounds and inserted flexible titanium rods in all four bones during a five-hour
operation. Brittany expected to remain hospitalized for another 24 hours.
Later that day, when she
developed severe pain in both arms that didn't respond to pain medication, her
care team suspected compartment syndrome, a group of signs indicating the
compression of nerves and blood vessels within the muscle tissue. "The muscles
are surrounded by thick, tough membranes called fascia," Casas said.
"Inside each layer of fascia
is a confined space called a compartment, which includes muscle tissue, nerves
and blood vessels," he added. "If there's swelling in an injury, nerves and
blood vessels are compressed within this compartment. Compression impairs blood
flow and ultimately can cause muscle and nerve damage."
That night, Casas was back in
the operating room (OR) with Brittany, making long incisions on the upper and
lower sides of her forearms to decompress the compartments.
Reconstructive microvascular
surgeon Emmanuel Melissinos joined Brittany's care team to evaluate and monitor
circulation to the muscle tissue and make sure decompression had occurred. When
the swelling subsided, Melissinos began reconstruction of the damaged tissue.
"We started on the top of the
forearms," he said. "Gradually, in several surgeries, we were able to move the
tissue around to make what we call a primary closure with her own skin. But
there were two areas on her forearms that remained swollen and couldn't be
closed." Melissinos grafted skin from high up on Brittany's thigh to the top and
underside of her forearms to close the wounds.
After the surgeries, she
developed severe muscle and joint contractures of the arm, hand, wrist and
elbow. "Her joints were scarred to the point that she couldn't rotate her
elbow," Casas said. "Her fingers were frozen, so we had to take her back into
the OR to manipulate the joints under anesthesia to break up the scar tissue."
Brittany was able to return to
school the last week in March. In total, she has endured 11 surgeries and more
than 20 weeks of occupational therapy to regain the use of her arms and hands.
She had her last operation on May 31 to remove the four titanium rods and
remained in splints until mid-July, when she was released for activities again.
When her arms have completely
healed and the tissue is soft and flexible, she'll go back to the OR for a final
outpatient procedure in which Melissinos will remove the grafts and close the
incision to eliminate the scarring.
 Both
Casas and Melissinos are impressed with Brittany's attitude and her will to
recover. "She's done remarkably well," Casas said. "It's a huge psychological
blow to go from being a top-notch competitor in athletics to being unable to use
your arms at all."
"She is a real dynamo," said
Melissinos. "She's been through so much that it's really gratifying to see her
doing so well. Being young, athletic and healthy – and having an athlete's will
to win – have helped speed her recovery."
Her mother Karen Berry agreed.
"In a heartbeat Brittany went from being extremely fit and athletic to being
totally dependent. For most of her hospital stay, we did everything for her. She
had big splints with bulky dressings, and she went through severe pain during
recovery.
"It's been a lot for a
13-year-old to go through, but she's already begun doing a little tumbling at
gymnastics, and she's started dance lessons. She won't return to competitive
gymnastics but she may try soccer or track, which she's always wanted to do.
She's a real trooper."
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