Fabian O., 11

Fabian is the second-born in a family of three and lives with his family in the Kibera slums. He enjoys playing football with his friends and dreams of becoming an engineer someday. His mother works as a casual laborer, depending on unpredictable, low-paying jobs to support the household, which makes it difficult to meet even their basic daily needs. Fabian has faced challenges since birth due to a congenital deformity of his upper limb, noted as a curved hand. Over the past month, he has developed persistent pain that has increasingly limited his ability to lift or use the affected arm. His mother began physiotherapy for him when he was four years old, but despite long-term efforts, there was no significant improvement. In November 2025, Fabian’s mother learned about a medical outreach camp organized by Helpster in partnership with Barika. She took him for evaluation on the 28th and 29th of November. After an initial assessment at the camp, Barika’s medical team referred Fabian for a specialized clinic appointment. Further examination confirmed that he had an elbow flexion contracture. The elbow flexion contracture limits Fabian’s ability to fully straighten or use his arm. This affects daily activities such as dressing, writing, carrying objects, and playing sports. It also contributes to persistent and chronic pain which Fabian has to endure day in day out, reduced strength, and social or emotional difficulties due to the noticeable deformity.

Fabian Onyango, did not undergo the planned surgery following a consultation with a plastic surgeon. Instead, the medical team decided to begin a course of non-surgical management through serial casting. The patient is to receive weekly serial casting for a period of approximately two months, after which his condition will be reassessed to determine whether surgery will still be necessary. This approach suggests that the doctors opted to first try a gradual corrective treatment before proceeding with any surgical intervention. Fabian Onyango was diagnosed with a chronic congenital elbow deformity that resulted in limited elbow extension and reduced range of motion. Initially, surgery was considered as a possible treatment option. However, following specialist review, the medical team opted for a conservative treatment approach using serial casting to gradually improve the position and function of the elbow. Over several weeks, Fabian underwent serial casting, with the casts being changed regularly to progressively increase elbow extension. The treatment produced positive results, and follow-up assessments showed steady improvement in the range of motion of the affected elbow. At his most recent review on 11th June 2026, the orthopedic surgeon noted that Fabian had responded well to the serial casting program. As a result, surgery was not recommended at that stage. Instead, the specialist advised transitioning to physiotherapy for a period of six weeks, focusing on range-of-motion exercises to strengthen the joint, improve flexibility, and maintain the correction achieved through casting. The prognosis is favorable, as Fabian has demonstrated significant improvement without requiring surgery. Continued physiotherapy is expected to further enhance elbow function and mobility, helping him regain greater use of his arm and reducing the likelihood of future complications. Regular follow-up assessments will be conducted to monitor his progress and determine whether any additional intervention is necessary.

If Fabian remains untreated, doctors anticipate a poor prognosis with progressive worsening of the elbow contracture, increasing pain, and permanent functional limitation of the affected arm. The medical team plans to manage his condition through surgical tendon release and elbow joint reconstruction, followed by structured physiotherapy, which is expected to relieve pain, restore range of motion, and improve arm function. This intervention is anticipated to significantly enhance Fabian’s independence, participation in daily and school activities, and overall quality of life.