 Upon arrival in the Hospital Emergency Department, he was noted to have an open left humerus fracture.  No other apparent injuries.  This was confirmed with radiographic imaging showing that the chest and pelvis x-rays were negative for any acute injury and that the cervical spine x-ray was negative for fracture malalignment.  The left upper extremity x-ray did demonstrate an open left distal humerus fracture.  The orthopedic surgery team was then consulted and upon their evaluation, the patient was taken emergently to the operating room for surgical repair of his left humerus fracture.  In the operating room, the patient was prepared for an irrigation and debridement of what was determined to be an open type 3 subcondylar left distal humerus fracture.  In the operating room, his upper extremity was evaluated for neurovascular status and great care was taken to preserve these structures.  Throughout the duration of the procedure, the patient had a palpable distal radial pulse.  The orthopedic team then completed an open reduction and internal fixation of the left supracondylar humerus fracture.  A wound VAC was then placed over the wound at the conclusion of the procedure.  The patient tolerated this procedure well and was returned to the Pediatric Intensive Care Unit for postsurgical followup and monitoring.  His diet was advanced and his pain was controlled with pain medication.  The day following his surgery, the patient was evaluated for a potential for closed head injury given the nature of his accident and the fact that he was not wearing a helmet during his accident.  A CT of the brain without contrast showed no acute intracranial abnormalities moreover his cervical spine was radiographically and clinically cleared and his C-collar was removed at that point.  Once his C spine had been cleared and the absence of a closed head injury was confirmed.  The patient was then transferred from the Intensive Care Unit to the General Floor bed.  His clinical status continued to improve and on July 26, 2008, he was taken back to the operating room for removal of the wound VAC and closure of his left upper extremity wound.  He again tolerated this procedure well on his return to the General Pediatrics Floor.  Throughout his stay, there was concern for compartment syndrome due to the nature and extent of his injuries.  However, frequent checks of his distal pulses indicated that he had strong peripheral pulses in the left upper extremity.  Moreover, the patient had no complaints of paresthesia.  There was no demonstration of pallor or pain on passive motion.  There was good capillary refill to the digits of the left hand.  By the date of the discharge, the patient was on a full pediatric select diet and was tolerating this well.  He had no abdominal tenderness and there were no abdominal injuries on exam or radiographic studies.  He was afebrile and his vital signs were stable and once cleared by Orthopedics, he was deemed appropriate for discharge.