An ATV accident turned a family vacation into a journey to save a young girl’s arm
When the Ward family set off on a vacation to Northern California for the Independence Day holiday in 2021, they had no idea that the trip would take a terrifying turn.
On July 3, 8-year-old Ella Ward was a passenger in a six-seat ATV being driven by her father, Sam, when the ATV unexpectedly overturned, pinning Ella’s arm underneath the roll bar. While the rest of the vehicle’s occupants escaped unscathed, the ATV slid, injuring Ella’s arm even further, until three adults were able to turn it upright and get Ella to safety. What happened next was a whirlwind for the little girl and her parents, who were vacationing on a ranch an hour ’s drive from the nearest children’s hospital.
“Ella’s arm was broken in between her wrist and elbow,” Sam recalls. “Not only that, but because of the movement of the ATV, she lost 50 percent of the muscle and 75 percent of the skin on her right forearm. So, along with the open broken bones, her arm was full of dirt, rocks and bacteria. It was mangled.”
“An ambulance transported the family to a hospital in Fresno. When they arrived, Sam says, “there was a flood of doctors and they were all extremely concerned—they didn’t know how they were going to address it.”
Ella was rushed into surgery. The surgeon, who’d been in the military, told the Wards that his plan was to treat Ella as if she were a soldier with a war wound.
“That’s how bad it was,” Sam says. “He said, ‘I know how dangerous this is and I’m going to hit it hard and treat it for infection.’ That’s how they started—cleaning the arm, treating infection and performing lifesaving measures.”
At this point, the Wards and Ella’s doctors were unsure if they would be able to save her life, let alone her arm.
“I am certain that if this accident had happened in many other states, Ella would have died from the severity of her injury,” her mother, Lindsey, says. “In most places, her arm would have been immediately amputated. We didn’t know for a while if hers would have to be—it was always a possibility.”
Ella underwent several surgeries in Fresno while her medical team decided on the best course of action. Doctors cleaned her wound and put her bones together with titanium rods. Then, they searched for another team of experts to take over the remainder of the extensive care Ella was going to need to repair her nerves, muscle and skin.
Searching For Success In San Diego
A week after the accident, the Wards left Fresno to head home to San Diego and meet with Katharine Hinchcliff, MD, a plastic surgeon at Rady Children’s and an assistant clinical professor at the UC San Diego School of Medicine who specializes in reconstructive surgery, pediatric and adult upper extremity surgery and peripheral nerve surgery.
“They originally wanted us to go to Stanford, but when we told them we lived in San Diego, they found Dr. Hinchcliff. They interviewed her and felt that she would be even better at getting Ella’s hand to work again,” Sam explains.
The family drove back to San Diego with Ella medicated and with a special vacuum to drain the open wound on her splinted arm.
“She was like a china doll, she was so fragile,” Sam says. “We left without them being able to find her radial artery. She still had 50 percent muscle loss and most of her skin missing. But they said she had an 80 percent chance of keeping her arm.”
Still, Lindsey adds, “We were told that even if she kept her arm, there wouldn’t be any function.”
The Wards arrived at Rady Children’s with hope that Dr. Hinchcliff would have a plan not only to save Ella’s arm, but to help her regain as much function as possible. They quickly learned that with an injury as severe as Ella’s, with such a high risk of infection, the best plan is to have no plan at all.
“The most difficult thing for a kid with this type of injury is trying to give them and their family a realistic idea of the prognosis and picture ahead when you don’t know for sure what that’s going to be,” Dr. Hinchcliff says. “Trying to tell a concerned family what to expect is a skill we all develop and are continually working on as trauma surgeons.
“You don’t want to paint too rosy a picture and get a family ’s hopes up,” she adds. “And you don’t want to paint too bleak a picture and have them give up hope. I can always tell where I think a patient is going to end up, but it relies on a lot of factors. You have to hedge all the pieces of the puzzle and come up with a summation that’s not going to overwhelm them.”
Despite the stress of not knowing what the future held, the Wards trusted that they were in the best hands with Dr. Hinchcliff and the team at Rady Children’s.
“Dr. Hinchcliff had no real plan of action when we met her,” Lindsay says. “We had to make a lot of our huge decisions while Ella was in the operating room. Still, even before meeting her, we knew she was an incredible person just based on her experience—and she was. She was incredible with her communication with us—we were able to reach her at any time—and treating us not just as patients, but as parents.”
“Dr. Hinchcliff ’s empathy made an impression on them, Lindsay says. “When you meet a lot of doctors, you realize some have empathy and some don’t. Dr. Hinchcliff does.”
Sam adds: “The first day we met her, she spent at least two hours with us. Then she came every day, for at least an hour, sometimes three hours. I asked her a million questions, and she answered every single one until I couldn’t think of any more to ask.
“Her bedside manner was absolutely over the top,” he continues. “She was candid about what happened, she was incredible at describing what she was going to do, and she told me to let her know the level at which I wanted to hear or see what Ella’s arm was like. I told her I couldn’t stomach it and I couldn’t mentally handle it, but if my kid had to handle it, I would, too.”
Enduring The Extreme
Over the next month that Ella was a patient at Rady Children’s, there was, in fact, a lot to handle. The first step was to find Ella’s radial artery, which sends oxygenated blood to the lower arm and the hand.
“That first surgery was supposed to be a basic surgery, but it ended up being one of the most important,” Sam recalls.
Dr. Hinchcliff found the radial artery—still attached to Ella’s hand. She put it back in place, removed some dead muscle, excised some dead skin and did some stitching to build up scar tissue in the hopes of getting the tendons to work again, Sam recalls.
“She gave that a 50/50 chance of succeeding,” he says, “and at the time we didn’t know how significant it would be.”
Finding the radial artery changed the course of action, and the next step was for Ella to undergo a muscle transplant to replace the forearm muscle she lost in the accident. After Dr. Hinchcliff performed a few more cleanings and tendon transfers to improve movement in Ella’s hand, she brought in her partner from UC San Diego to assist with a flap surgery, a reconstructive technique to remove a piece of tissue from one site where it has a blood supply to another site. In Ella’s case, the donor site was the muscle in her upper left back, which was removed and attached to the injured area of her arm.
“The human body is nice in that it has a lot of spare parts and a lot of redundancies, so there are certain muscles you can do this with,” Dr. Hinchcliff explains. “The muscle we took from Ella’s back is a workhorse muscle in that it’s often used in scenarios like this where you don’t need them as intended. My partner came in and worked on her back while I worked on the vessels in her arm.”
After the 10-hour surgery, Ella was transferred to the intensive care unit because the new muscle—which was completely exposed without any skin—had to be continuously monitored.
“The ICU nurses were listening to her heartbeat for hours, making sure the transplanted muscle was receiving blood. If the blood flow to the muscle stopped, she would have had to go immediately back to the OR—it was critical to keep that muscle alive,” Sam says. “Essentially, for the next four days in the ICU, the job was to monitor that muscle.”
Ella also needed a blood transfusion. She was on a PICC line and an IV for medication, nutrition and liquids.
“She was a wreck,” Sam says. “Even though it was a successful surgery, we weren’t through the woods yet. We knew things could go south at any minute.”
Luckily, the muscle transplant took, and Ella could move forward to the next step: a skin graft that involved removing skin from her upper thighs and transplanting it to her arm. Once the graft was complete, the surgeons’ work was nearly done, but Ella’s was just beginning.
On To OT
The week after the skin graft was trying for Ella. She wouldn’t eat. She was sick. And she still had a long journey ahead of her to get her newly repaired arm back to normal functioning.
“We got her arm fixed but at what cost?” says Sam. “It was scary for us because we still didn’t know what to expect. With the arm, it’s not just a procedural or medical fix; it’s also functional. So, I had questions: Will she be able to write again? It wasn’t promising. Will she be able to turn a doorknob? Possibly. Will she be able to ride a bike? Maybe. You just keep listing things in the hopes of hearing yes. We were told they thought Ella’s hand would likely be more like a helper hand. There was still this black cloud hanging overhead.”
That’s when occupational therapist and certified hand therapist Denise Hoover entered the picture. Hoover, who has been with Rady Children’s for 31 years, is one of just three pediatric certified hand therapists in San Diego and the only one still in practice. She’s also a key to Ella’s success story.
“One thing I’d emphasize about Ella is that she has a really good outcome and it’s in large part due to her therapist,” Dr. Hinchcliff says.
“When we met Denise, Ella couldn’t use her hand at all,” Sam recalls. “Denise said, ‘I’ve been prepared to see her. She’s going to be one of the biggest challenges I’ve ever faced, and I’m ready to take it on.’ ”
At that point, Ella wasn’t able to pick up anything or move her elbow. She could barely move her fingers.
“As recently as a few months ago, she couldn’t touch her face with her palm, only the back of her hand,” Sam says. “Now, speeding through to today, she has 90-percent function in her hand. She can write. She can do handstands! Seeing where she’s been to where she is now is incredible.”
Dancing Down The Road To Recovery
Ella, who is a dancer, is now back to practicing four days a week—a feat that her mother says was unexpected. Lindsey credits Denise’s hard work and passion, and the powerful one-two punch she provided after Dr. Hinchcliff ’s surgical work.
We are so beyond blessed that we’re from San Diego and that we got to stay in San Diego throughout all of this,” Lindsey says.
“I truly believe that if we were somewhere else, we wouldn’t have gotten this result. Denise Hoover deserves a lot of credit for the function Ella got back. If Denise hadn’t been her OT, I don’t know if we would have the recovery we had. The doctor can only do so much.”
Lindsey describes Denise and Dr. Hinchcliff as “probably the best hand team in America.”
“I don’t know any other hand teams,” she laughs, “but I’m sure of it!”
While Ella continues to improve, her healing journey isn’t complete. She still does not like to look at her arm—especially after she has surgery. She has undergone trauma therapy at the Chadwick Center for Children & Families at Rady Children’s. After 13 surgeries—10 of which were at Rady Children’s—she will still need to undergo procedures with Dr. Hinchcliff to improve the skin’s appearance. But, according to her grateful parents, her hand function is back and, best of all, so is her quality of life.
“We didn’t know what her quality of life would be, but we’re back to her being a normal kid again. The growth is ongoing, but the heavy, horrible, lifesaving, life-changing stuff is behind us now,” Lindsey says.
“Now we’re taking it one day at a time and one step at a time,” Sam adds. “If you were to ask Ella if she’d go back and change it and not have been through the accident, it’s not like an immediate yes. She thinks about it for a bit—like, ‘Look, I am who I am, and I’ve gone through it.’ She has a story and an arm that no other kid has. She earned that arm. We tell her, ‘This is your tough arm—let’s keep fighting for it.’ She’s a tough kid and she has a lot of tough things to say that are beyond her years. We’re lucky to have her as our fighter.”