- Discussion:
- vascular compromise occurs in about 5-20% of children w/ supracondylar frx;
- less than 1% will be complicated by
compartment syndrome and the resulting sequelae of
Volkmann's contracture;
- note that a median nerve palsy, may mask a pending compartment syndrome (because there will be no pain);
- frxs w/
posterolateral displacement of distal fragment are more susceptible to vascular injury, since the medial spike of the proximal humerus can
tether the
brachial artery;
- Treatment:
- while patient is being worked up, consider applying a continuous
pulse ox so nurses can follow an objective measurement of perfusion;
-
arteriography:
- fracture reduction usually restores the pulses, and therefore reduction should not be delayed by waiting for an angiographic
study;
- arteriography is only indicated if circulation is not restored following
reduction
- if circulation is not restored by
closed reduction, immediate
open reduction and surgical exploration of the artery is indicated;
- arteriography is not indicated since it provides little additional information and only delays restoration of circulation to the extremity;
- morbidity assoc w/ surgical exposure of the artery is low;
- procrastination will only increase patient morbidity;
-
Management Arterial Trauma:
- see
intimal injuries and
microvascular technique
Management of vascular injuries in displaced supracondylar humerus fractures without arteriography.
Acute neurovascular complications with supracondylar humerus fractures in children.
Arterial reconstruction using the basilic vein from the zone of injury in pediatric supracondylar humeral fractures: a clinical and radiological series.
Microsurgical reconstruction of brachial artery injuries in displaced supracondylar fracture humerus in children.
Pulseless arm in association with totally displaced supracondylar fracture.
The pink pulseless hand
Pink pulseless hand following supra-condylar fractures: an audit of British practice
Management of pulseless pink hand in pediatric supracondylar fractures of humerus.
